Objective:

To describe an older adult with SSSS and the diagnostic challenge of distinguishing it from toxic epidermal necrolysis.

Approach:

• Case: An 88-year-old woman with untreated diffuse large B-cell lymphoma presented with fever and rapidly spreading superficial desquamation. Mucous membranes were spared.
• Diagnostic evaluation: Blood cultures, skin biopsy, and clinical examination were used to distinguish SSSS from SJS/TEN and bullous pemphigoid.
• Treatment: After empirical vancomycin and ceftriaxone, therapy was narrowed to oxacillin and then cefazolin, alongside wound care, pain control, and nutritional support.

Key Findings:

• Blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA).
• Skin biopsy showed intraepidermal cleavage and subcorneal splitting, findings consistent with SSSS.
• Mucosal sparing and superficial desquamation supported SSSS, while the patient’s advanced age heightened concern for TEN.
• The patient improved with targeted antibiotics and supportive care, with progressive re-epithelialization.

Interpretation:

The authors report that mucosal sparing, MSSA bacteremia, and biopsy findings together established SSSS despite its clinical resemblance to TEN. The patient had untreated diffuse large B-cell lymphoma and preserved renal function.

Limitations:

• This is a single-patient case report and does not establish how frequently these findings occur or compare treatment outcomes.

Sources:

• Article context provided