Case Study

Question 1

Pathway to Right Dx

Answer 1

History and PE
Look at population group
List of Differential Dxs
Order labs and tests
Gather evidence
Final Dx

Question 2

What labs confirm SSS?

Answer 2

High ESR/CRP but platelet normal
Gram stain - Gram + cocci, in pairs
Biopsy –> desquamation

Skin culture –> Staph aureus in high amounts

Question 3

Differential w/ Childhood exanthema

Answer 3

Viral
Scarlet fever (do throat culture)
Thermal burns
Pemphigus
Kawasaki
Staphylococcal Scalded Skin Syndrome

Question 4

exanthema

Answer 4

rash w/ fever/disease

Question 5

Fifth Disease

Answer 5

“Slapped cheeks”
Parvovirus
fever and joint pain

Question 6

Pemphigus

Answer 6

Blistering AI
Autoantibodies vs. desmoglein
Skin biopsy

Question 7

Scarlet fever

Answer 7

Group A strep
Fever
Throat swab for strep

Question 8

Kawasaki

Answer 8

AI vasculitis (no protein)
Skin, mucous membranes, blood vessels, heart
High fever, rash, red eyes, enlarged lymph
DX - hx, PE (no labs)

Question 9

SSS causative agent

Answer 9

Coagulase positive staphylococci – exfoliatin extracellular toxin

Question 10

Exotoxin destroys keratinocyte attachments in the stratum granulosum only (vs. toxic epidermal necrolysis, which destroys the epidermal-dermal junction). Characterized by fever and generalized erythematous rash with sloughing of the upper layers of the epidermis that heals completely. Seen in newborns and children.

Answer 10

SSSS

Question 11

Tx for SSS

Answer 11

Beta-lactamase resistant penicillin (ampicillin/sulbactam) or penicillinase-resistant penicillin (nafcillin)

Isolation