Scalded Skin Syndrome Caused by a Methicillin Sensitive Staphylococcus aureus of a type not commonly associated with exfoliative toxins in Scotland.

A three-year-old boy was admitted to the hospital with a three-day history of chickenpox and a one-day history of fever and enlarging skin lesions on his chest, trunk, and around his neck. The lesions were enlarged and skin peeling over the chest wall was noted. Despite starting him on Flucloxacillin/Aciclovir, new lesions were noted with blisters over chest, legs, arms and buttocks. A clinical diagnosis of Staphylococcal Scalded Skin Syndrome (SSSS) was made and laboratory results confirmed Methicillin sensitive Staphylococcus aureus (MRSA) isolation. The isolates were sent to Scottish MRSA reference lab (SMRSARL) for typing and toxin detection. The isolate from this child was positive for the exfoliative toxin A (eta) gene and negative for exfoliative toxin B, toxic shock syndrome toxin, panton-valentine leukocidin and entertoxins A, B, C, D, E. By Pulse Field Gel Electrophoresis (PFGE) this isolate was identified as MLST Type 88 clone which has been associated with skin lesions in other countries.