This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'A 3–month–old male infant developed otitis media for which he was given a course of Co-trimoxazole. A few days later, he developed extensive peeling of the skin; there were no mucosal lesions and the baby was not toxic. The most likely diagnosis is – \nSelect and explain. \nA. Toxic epidermal necrolysis, B. Staphylococcal scalded skin syndrome, C. Steven Johnson syndrome, D. Infantile pemphigus', 'role': 'user'}, {'content': "Answer: B \nExplanation: The extensive peeling of the skin after H/0 drug intake makes it look like a case of Toxic epidermal necrolysis or Steven's Jhonson syndrome on the first instance. But it is a case of staphylococcal scalded skin syndrome.\nNote that all the disease given in the question can cause extensive peeling of the skin.\nThe points which favour the diagnosis of staphylococcal scalded skin syndrome are\nMucosa is spared in staphylococcal scalded skin syndrome.\nThe absence of toxicity.\nS.S.S. usually have a primary infection at sites other than skin eg - Nasopharynx, conjunctiva, throat middle ear (otitis media).\nNow, about the individual diseases —\n\n\nStaphylococcal scalded skin syndrome\n\nUsually begins as prodrome. The acute phase starts with the onset of erythematous rash in the periorbital and perioral area and is tender.\nThese erythematous rashes are soon (within hrs or days) followed by wrinkling or sloughing of the skin.\nThe sloughing can be provoked by stroking of the skin (Nikolsky's sign).\nIn a later stage, large flaccid bullae may develop. These bullae can cause loss of water and electrolyte.\nFever irritability and lethargy are common but systemic toxicity is not seen.\nThe entire illness resolves within about 10 days.\n\nToxic epidermal necrolysis -\n\nIt is a severe form of drug reaction.\nToxaemia is characteristic\nIt is characterized by bullae that arise on widespread areas of erythema and then they slough leaving behind raw ulcerated skin.\nOral mucosa especially the lips, genital mucosa and conjunctiva are often involved. In some cases, the cornea is also involved leading to corneal opacities.\nDrugs commonly involved in TEN are → Thioacetazone, INH, Sulphonamides, Phenolphthalein\n\nStevens Jhonson syndrome -\n\nIt is also a severe form of drug eruption.\nToxaemia is characteristically present.\nIt is less severe than toxic epidermal necrolysis. In Steven's Jhonson's syndrome bullies and epidermal detachment is seen in > 10% of the total surface area. Whereas in TEN it is seen in > 30% of the total surface area.\nThe mucous membrane is involved\nCommon drugs causing this reaction → Sulphonamides, Tetracycline, Oral antidiabetic drugs.", 'role': 'assistant'}]