Recurrent varicella complicated with staphylococcal scalded skin syndrome in an immunocompromised child

Abstract

Immunocompromised children are at increased risk of recurrence and reactivation of varicella and its various complications. Staphylococcal scalded skin syndrome (SSSS) is an exfoliative dermatitis caused by toxicogenic strains of Staphylococcus aureus. Recurrent varicella lesions can predispose to S. aureus infection, and in the immunocompromised patients, SSSS can rapidly lead to multi-organ failure and death. A 3-year-old male child, on immunosuppressive therapy for acute lymphoblastic leukemia, presented with recurrent varicella infection. After initial improvement, there was deterioration due to the development of secondary bacterial infection and SSSS. He also developed septic shock and disseminated intravascular coagulation. The child recovered with antimicrobial therapy combined with aggressive supportive care. SSSS may present as a complication of varicella infection and is of special importance in immunocompromised. Even with such a rare combination of lethal conditions in the background of immunosuppression, where both diagnosis and treatment is a great challenge, early institution of appropriate therapy may lead to successful outcome.