When rashes mislead: the case of a dramatic bullous impetigo

Abstract

A 3-month-old male presented with a rapidly spreading blistering rash, starting periorally and evolving into crusted erosions without mucosal involvement. The patient was afebrile and systemically well. Workup was negative except for wound culture growing methicillin-susceptible Staphylococcus aureus. The patient was diagnosed with bullous impetigo and improved with ampicillin-sulbactam. This case highlights the need to recognize bullous impetigo despite its dramatic appearance. The patient improved rapidly and was discharged, with complete recovery noted at follow-up. This case underscores the importance of early recognition of bullous impetigo, its sometimes-alarming clinical presentation, and the role of culture-guided therapy in pediatric patients with extensive cutaneous involvement.