Fatal case of staphylococcal scalded skin syndrome associated with topical-steroid-induced iatrogenic cushing syndrome due to potent topical steroid (LS BL cream) application: A rare case report in a 3-month-old female

Authors:

Joanne Kate T. Milana – Martinez, MD, Elisa Rae L. Coo, MD, Diandra Aurora R. Zabala, MD, Jennifer Aileen A. Tangtatco, MD, DPDS, Maricarr Pamela M. Lacuesta – Gutierrez, MD, FPDS

Abstract

Introduction: In pediatric patients, the mortality rate of staphylococcal scalded skin syndrome (SSSS) is very low.  However, SSSS can become critical and potentially fatal with underlying sepsis, superinfection, dehydration and electrolyte imbalance due to denuded skin.  Moreover, Cushing syndrome caused by application of topical corticosteroids is rarely reported.

Case Summary: This is a case of a 3-month old female who was referred to our department due to generalized erythema with desquamation. History revealed that the patient had recurrent eczema and the mother applied an over-the-counter medication containing Ketoconazole+Clobetasol cream thrice daily for ten weeks.  The estimated topical steroid applied weekly was around 8.5 grams and at time of admission, the patient had been given approximate total of 50 grams of potent corticosteroid. The patient presented with fever, irritability, and had positive Nikolsky’s sign thus managed as a case of staphylococcal scalded skin syndrome associated with topical steroid – induced iatrogenic Cushing syndrome. Unfortunately, patient’s condition worsened and with progressive pneumonia, she expired on the 23rd hospital day with final diagnosis of Sepsis secondary to Health Care Associated Pneumonia, Acute Kidney Injury, Electrolyte Imbalance and Cushing syndrome.

The fatal outcome is due to SSSS which was complicated by progressive pneumonia and topical steroid – induced iatrogenic Cushing’s syndrome.  The complex interplay of the features of these conditions eventually led to sepsis and death.

Conclusion: This case highlights the risks related to abuse of potent steroid-containing preparations and the importance of education to prevent severe and catastrophic outcomes of injudicious steroid use.

 

Citation

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Keywords

Iatrogenic Cushing syndrome, Staphylococcal Scalded Skin Syndrome, potent topical corticosteroid, adverse effects, awareness

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