Scarlet Fever

A 2-day history of fever and sore throat and an erupting rash prompted the mother of a 5-year-old boy to bring her son into the office for evaluation. This case demonstrates typical aspects of a disease now seen far less often than in the past-scarlet fever.

The physical examination revealed intensely injected, enlarged tonsils with purulent exudate in the crypts (Figure 1). The soft palate also was intensely erythematous. On each side of the tongue blade, a “white strawberry” tongue is evident as the reddened edematous papillae project through the tongue's white coating. Anterior cervical glands were enlarged and tender.

A day before presentation, a fine, sandpaper-like rash erupted in the genital area (Figure 2). The rash spread to the patient's anterior trunk, back, and upper thighs.

A test for rapid identification of group A β-hemolytic streptococci was positive, confirming the diagnosis of scarlet fever. A 10-day course of amoxicillin, 250 mg three times a day, was prescribed.

Two days later, while his condition was improving and the exanthem was fading, the skin of the youngster's genitalia began to desquamate; this is a characteristic feature of scarlet fever. The hyperpigmentation of the skin and the Pastia lines in the inguinal areas also are seen commonly in this disease. This boy completed the antibiotic therapy, and his recovery was uneventful.