An 8-Year-Old Girl with Persistent Sore Throat and Fever

 Differential Diagnosis

• Toxic shock syndrome
• Kawasaki disease
• Scarlet fever
• Mononucleosis

 

Diagnosis

The patient was diagnosed with scarlet fever, an acute toxin-mediated disease caused by infection with group A beta-hemolytic streptococci (Streptococcus pyogenes), and most common in children under 10 years of age.

Learnings/What to Look for

• The characteristic rash associated with scarlet fever begins within 12 to 48 hours of fever onset
• Associated prodromal symptoms include fever and malaise
• Sore throat and swollen, tender anterior cervical lymph nodes are typical
• Abdominal pain, nausea, and vomiting are common in younger children
• Petechiae may be present on the soft palate.

Pearls for Urgent Care Management and Considerations for Transfer

• Penicillin or amoxicillin is considered first-line treatment for scarlet fever
• In patients who are allergic to penicillin, a narrow-spectrum cephalosporin, clindamycin, azithromycin, or clarithromycin would be appropriate

Acknowledgment: Images and case courtesy of VisualDx (www.VisualDx.com/JUCM).