Toxic epidermal necrolysis versus staphylococcal scalded skin syndrome: A diagnostic confusion in a 2-year-old child with ceftriaxone therapy

Toxic epidermal necrolysis (TEN) is a rare, but serious condition characterized by widespread death of epidermis involving skin and mucous membrane. Ceftriaxone-induced TEN in the pediatric age group is rare. Hereby, we present a child of 2 years, who was treated for food poisoning with ceftriaxone, amikacin, and ranitidine. The child developed generalized rash and hyperpigmentation with mucosal involvement. A diagnosis of staphylococcal scalded skin syndrome (SSSS) was considered initially, and ceftriaxone was advised to continue. Since the lesions aggravated and therapy was ineffective, ceftriaxone was discontinued. A diagnosis of ceftriaxone-induced TEN was made and treated symptomatically. The patient was discharged with complete recovery. Naranjo's algorithm showed a possible relationship with the adverse event. Ceftriaxone is generally considered safe in the pediatric population but still needs a watchful eye on the development of TEN as it closely resembles SSSS.