Methods: A 10 month old boy symptoms started two days before with upper airway tract infection, external otitis and some urticarial eruption on his body without fever. He was put on oral antihistamin and antibiotic treatment. He was reffered to our Department because of high fever, conjunctivitis, stomatitis and redness of his skin all over his body with some blister formation. He was unable to eat, he was in pain but sleepy. After a few hours of his admission his fever became 39 C , severe exfoliation occured, and some large flaccid bullaes appeared and erupted, drained an amber-colored liquid and spreaded to cover extensive areas of his body revealing denuded skin. His history and symptoms suggested allergic reaction for his medication or autoimmun/ mucocutaneous disoder but interestingly his laboratory tests were in the normal range. In spite of these to prevent a bacterial superinfection after bacterial culturing of throat, nose, skin, and blood, we introduced iv amoxicillin/ clavulanic-acid therapy, cyclesonide eye drops, antiseptic local treatment of mouth ( chlorhexidine digluconate) and skin ( unguentum antisepticum). After 2 days his fever stopped and the top layer of his skin started to come off, partly powdery scales formed.
Results: The symptoms started to resolve slowly and the child became symptome free after 10 days. Bacterial culturing results confirmed the diagnosis of SSSS. The antibiotic treatment was completed on the tenth day.
Conclusions: Symptomes and appearence of the disease suggested several diseases but the laboratory test were normal, making the diagnosis more difficult, the supposed diagnosis did not fit properly for the patient age. Careful observation of patients and the disease, exfoliative cytology and a biopsy, microbiological investigations allow the diagnosis, ruling out erythema multiforme and drug-induced toxic epidermal necrolysis, both which are similar to SSSSyndrome.