RESUMO
We report a 4-year-old boy with cellulitis and scarlet fever due to streptococcal infection following the onset of varicella. He developed a painful ulcer and subcutaneous induration on the left shoulder and a small, light-red-colored rash on the trunk at approximately the same time as the development of vesicles over the entire body. Streptococcus pyrogenes was isolated from samples from the posterior intranasal space and the ulcer on the shoulder. The clinical symptoms improved with the administration of antibiotics and intravenous drip infusion, but it took approximately one month from the first visit for the subcutaneous induration to disappear and the ulcer to heal with epithelialization. The complication of secondary streptococcal infection in varicella is relatively rare in Japan, but in Western countries there have been many reported cases of life-threatening necrotizing fasciitis and necrotizing pyomyositis due to secondary streptococcal infection following varicella. Close attention should be paid to streptococcal infection as a complication of varicella.
Assuntos
Celulite (Flegmão)/diagnóstico , Varicela/diagnóstico , Escarlatina/diagnóstico , Celulite (Flegmão)/complicações , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/patologia , Varicela/complicações , Pré-Escolar , Diagnóstico Diferencial , Humanos , Masculino , Escarlatina/complicações , Escarlatina/tratamento farmacológico , Escarlatina/patologia , Ombro , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
We report a case of staphylococcal scalded skin syndrome (SSSS) in a 5-year-old girl who had been hospitalized for burn treatment. When she developed an upper respiratory tract infection, she manifested extensive erythema and exfoliation. There was a purulent discharge from the ulcer caused by the burn, and exfoliation was observed in the surrounding area. Based on clinical symptoms and laboratory data, SSSS was diagnosed and treated with antibiotics, resulting in subsidence. Staphylococcus aureus was isolated from the posterior nasopharynx and the skin erosion and was proved to produce exfoliative toxin A (ETA). Infection from an asymptomatic carrier of an ET-producing strain was suspected, but we failed to identify the origin, in spite of a thorough inspection of the mother, nurses, and physician. SSSS is occasionally reported as a hospital-acquired infection. We should study the frequency of asymptomatic carriers of ET-producing strains so that we can formulate strategies to prevent such infections.
Assuntos
Queimaduras/complicações , Doença Iatrogênica , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Braço , Dorso , Cefalosporinas/uso terapêutico , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Síndrome da Pele Escaldada Estafilocócica/complicações , Síndrome da Pele Escaldada Estafilocócica/tratamento farmacológico , Síndrome da Pele Escaldada Estafilocócica/patologia , CefpiromaRESUMO
We report a case of staphylococcal scalded skin syndrome (SSSS) in a 65-year-old healthy woman. Fever, purulent conjunctivitis, and exfoliation of the skin in the gluteal region were noted. A scarlatiniform rash was observed on the body, and this erythema was followed by generalized desquamation. Staphylococcus aureus was isolated from her eye discharge, posterior nasopharynx, and the erosive surface of the skin. All the investigated strains produced exfoliative toxin B, but none produced toxic shock toxin-1 (TSST-1) or enterotoxin. The patient was treated with antibiotics and fluid supplementation, resulting in subsidence. This case is thought to have been caused by an abortive form of SSSS or a scarlatiniform variant, which is very rare in healthy adults.
Assuntos
Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Idoso , Nádegas , Dermotoxinas/isolamento & purificação , Diagnóstico Diferencial , Infecções Oculares Bacterianas/diagnóstico , Feminino , Humanos , Síndrome da Pele Escaldada Estafilocócica/patologiaRESUMO
We present here a case of pyoderma gangrenosum (PG) on the stump of an amputated leg. The patient was a 69-year-old woman who had both of her legs amputated due to acute arterial occlusion. An ulcer first appeared nine years later, after which point it continued to fluctuate in size. Complications included regional blood flow disorder at the amputated stump, diabetes, and secondary infection. Despite various therapies, the ulcer exacerbated, and hypoproteinemia, increased CRP, and fever were confirmed. The patient was diagnosed as having PG based on her clinical symptoms and because the ulcer did not respond to various therapies. The ulcer improved significantly in response to administration of 40 mg/day of prednisolone, and complete epithelialization was later achieved. Given the presence of multiple complications, it was extremely difficult to confirm PG. Therefore, it is important for physicians to consider PG as one of the causes of intractable ulcers.