A 7-year-old girl presents to the Emergency Department with a 2-day history of rapidly worsening painful skin lesions. She has had 7 days of fever, sore throat, malaise, and red, painful eyes. Yesterday, she noticed blistering on her chest and face.
On arrival, she is hypotensive at 87/45 mmHg, febrile at 38.9°C, tachycardic at 128 bpm, and appears acutely unwell.
Examination:
Widespread erythematous macules with confluent blistering
Positive Nikolsky sign
Large areas of epidermal detachment over trunk, back, and face
Involvement of oral mucosa, conjunctivae, and genital mucosa
Estimated BSA detachment 42%, consistent with Toxic Epidermal Necrolysis (TEN)
Laboratory findings: metabolic acidosis, raised lactate, mild AKI, transaminitis.
You initiate fluid resuscitation, strong analgesia, involve the paediatric team, and arrange urgent transfer to a regional burns centre / PICU.
You suspect this could be infection-related TEN. A medical student asks which infectious agent is most strongly associated with this condition.
Which of the following viral pathogens is most commonly related to SJS/TEN in this context?