Staphylococcal Scalded Skin Syndrome in Adults

To the Editor.—  Reid et al¹ have admirably documented a case of staphylococcal toxic epidermal necrolysis (TEN) in an adult who had renal failure and impaired delayed hypersensitivity. As recently stated,² the distinctive histologic features of drug-induced vs staphylococcal TEN allow rapid differentiation between these two entities, which can then be treated by appropriate therapy, pending results of culture studies. Isolation of group 2 organisms and demonstration of their exfoliative capacity in neonatal mice is usually much more time-consuming (and perhaps less reliable, since such organisms could be secondary invaders²).In seeking to explain the generalized TEN in their patient, Reid et al focused on the immunological defect discovered. The fact that in this case, as well as in the case reported earlier by Levine and Norden,³ the patients had renal insufficiency was not considered important per se. I suggest that while immune factors may have