The clinical syndrome described as severe, tender erythema with epidermal peeling in an infant is most consistent with infection by which organism?

• A. Streptococcus pyogenes
• B. Bacillus anthracis
• C. Erysipelothrix rhusiopathiae
• D. Staphylococcus aureus

Answer: (D)

This presentation is classic for scalded skin syndrome caused by Staphylococcus aureus. The bacteria produce exfoliative toxins that act as proteases to cleave desmoglein-1 in the superficial epidermis. This disrupts cell–cell adhesion in the upper layers of the skin, causing widespread tender erythema with peeling of the epidermis, a pattern especially seen in infants who have not yet developed adequate neutralizing antibodies. The other organisms listed don’t produce this toxin-driven skin peeling pattern: Bacillus anthracis causes a black eschar, Erysipelothrix rhusiopathiae causes a localized erysipeloid lesion, and Streptococcus pyogenes typically causes erysipelas or necrotizing infections rather than diffuse epidermal peeling.