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You are seeing a 2-year-old girl with 2 days of a rapidly progressing sunburn-like rash. She has a blanching generalized erythema of her trunk, accentuated on the nape of the neck, axillae, and groin areas. The rash is not itchy but does seem tender to the touch. She has some cheilitis (fissuring at the corners of her mouth) but no mucosal involvement otherwise. She has some very mild swelling around her eyes and mucopurulent drainage in the medial canthi of her eyes. She has been afebrile at home. Vital signs in the ED are: temp 37.8 C, HR 110, RR 24, BP 72/38. She has not taken any medications and there has been no exposure to new foods or topical products. She was not out in the hot sun. She is unimmunized by parent choice.
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April 7, 2026 at 12:22 pm
I am not clear about how to find out the actual answers to the questions. I can see the poll/vote results but not a way to find out what the real answer is – and what the diagnosis/treatment/ etc might be.
April 7, 2026 at 1:30 pm
D) Staph scalded skin syndrome
SSSS is seen most often in young children < 6 years old. An initial skin infection by an exotoxin-producing strain of S. aureus results in SSSS, which is characterized by diffuse tender erythema accentuated in skin folds. As the disease progresses, there is formation of flaccid bullae and desquamation; Nikolsky sign is positive. There may be crusting and fissuring around the eyes, nose, and mouth. Many patients have nonspecific prodromal symptoms of fever, malaise, irritability. SSSS patients are admitted to the hospital for IV antibiotics and close observation. SJS is characterized by target lesions that progress to blistering and mucosal involvement. TSS is due to an exotoxin-producing Strep and Staph strains and patients are typically febrile and hypotensive, with a negative Nikolsky sign. Patients with Kawasaki disease have fever, and patients with measles have a morbilliform rash, fever, and the 3 C’s: cough, coryza, and conjunctivitis.
April 7, 2026 at 1:31 pm
Hi Betty. I usually post the answers within a day or two of posting the question. I try to let the question percolate for at least half to one day so people can think about it. Also, sometimes I’m working or on vacation and I don’t post the answer for several days (sorry about that). The answers are posted as a comment below each question.