Exfoliative dermatitis in an infant. Association with enterotoxin F-producing staphylococci

A 2-month-old premature infant had an extensive exfoliative dermatitis with flaccid bullae, mucous membrane involvement, thrombocytopenia, and an elevated creatinine kinase level. A subepidermal cleavage plane with numerous necrotic epidermal cells and a polymorphonuclear cell infiltrate were present on a skin biopsy specimen. The isolates of Staphylococcus aureus obtained at the onset of her disease had a 29/52 bacteriophage lysis pattern and produced enterotoxins C and F and epidermal toxin, but no exfolliatins. In toxic shock syndrome (TSS), subepidermal blister formation has been described and a new toxin, epidermal toxin, which causes subepidermal cleavage in the newborn mouse model, has been identified. In some infants, exfoliative dermatitis may be a variant of the well-described TSS in older children and adults.