Staphylococcal Scalded Skin Syndrome (SSSS) in a Preterm Infant: Clinical Presentation and Role of Next-Generation Sequencing in Toxin Gene Identification—A Case Report

Staphylococcal scalded skin syndrome (SSSS) is a rare, toxin-mediated dermatosis caused by exfoliative toxin-producing <i>Staphylococcus aureus</i> strains, with neonates and preterm infants being particularly vulnerable due to immature immunity and reduced toxin clearance. We report the case of a male preterm infant, born at 24 weeks of gestation, who presented at the age of one month with fever and later developed widespread erythema, flaccid bullae, and periorificial desquamation. Methicillin-sensitive <i>S. aureus</i> (MSSA) was isolated from blood, catheter, and auricular swabs. Whole-genome sequencing revealed sequence type ST121 carrying both <i>eta</i> and <i>etb</i> genes, confirming the dual-toxin profile associated with severe disease. The infant improved with targeted intravenous oxacillin following catheter removal. A subsequent nasal swab identified a methicillin-resistant <i>S. aureus</i> (MRSA) ST30 strain lacking exfoliative toxins, consistent with asymptomatic colonization. This case underscores the importance of integrating advanced molecular diagnostics such as next-generation sequencing into the management of neonatal SSSS, enabling precise identification of virulence factors and resistance genes. Literature also highlights the global epidemiology of SSSS, diversity of <i>S. aureus</i> toxin genes, and value of genomic surveillance in neonatal care; our case aligns with reports of ST121 strains carrying both ETA and ETB, where the dual-toxin profile drives rapid onset, extensive skin disease, and good outcomes with prompt therapy.