Pediatric Bullous Impetigo: A Case Report and Literature Review

TL;DR

A case report of a young girl with bullous impetigo highlights the importance of early diagnosis and treatment in children.

Contribution

The paper presents a pediatric case of bullous impetigo and emphasizes clinical considerations for accurate diagnosis and management.

Findings

Bullous impetigo can present with localized flaccid bullae and honey-colored crusts in children.

Intravenous cefazolin and topical fusidic acid improved symptoms effectively.

Early clinical recognition helps avoid misdiagnosis and unnecessary tests.

Abstract

Impetigo is a common superficial bacterial skin infection characterized by vesiculobullous or crusted lesions. Bullous impetigo presents with flaccid bullae that rupture easily, leaving superficial erosions and thin crusting. Unlike staphylococcal scalded skin syndrome, the blistering in bullous impetigo remains localized because the exfoliative toxins act within the skin rather than disseminating systemically.

We report the case of a previously healthy two-year-old girl who presented with gradually progressive pruritic erosions and honey-colored crusts localized to the right lower limb. Two siblings had similar but milder perioral lesions, which were briefly assessed clinically and considered consistent with early, limited impetigo, suggesting a possible small household cluster. Clinical evaluation supported a diagnosis of bullous impetigo. She received intravenous cefazolin in addition to topical fusidic acid and emollients, leading to steady improvement in pain, pruritus, and lesion appearance.

This case underscores the importance of early recognition of bullous impetigo and highlights practical considerations in its diagnosis and treatment, particularly in pediatric patients. A clear clinical approach can help avoid misdiagnosis, reduce unnecessary investigations, and guide appropriate antimicrobial therapy.

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