Image IQ: An 8-year-old girl with a sore throat, deep red tongue, fever and a petechial rash.

Image IQ:  Image IQ:  An 8-year-old girl with a sore throat, deep red tongue, fever and a petechial rash. What’s your diagnosis? (Photo courtesy of VisualDx 2018)

An 8-year-old girl was seen by her pediatrician for sore throat, deep red tongue and fever lasting several days in which a petechial rash appeared spreading from her head and neck down her torso. She complained of nausea and appeared ill.

What’s your diagnosis?

A. Toxic shock syndrome
B. Kawasaki disease
C. Scarlet fever
D. Mononucleosis

Visit the next page for the answer.

The correct answer is C:  Scarlet fever

Scarlet fever is an acute infection caused by the erythrogenic exotoxin of group A streptococcus, Streptococcus pyogenes. It occurs most frequently in children aged between 2 and 10 years. Streptococcal pharyngitis is the usual cause of scarlet fever; however, septic streptococcal infection, cellulitis, and infection during the puerperal period or surgery can initiate scarlet fever. The rash usually begins 1-2 days after symptoms of pharyngitis. After a 2-5 day incubation period, fever, nausea, vomiting, chills, malaise, and symptoms at the site of primary infection (usually the oropharynx) occur. Generalized lymphadenopathy occurs frequently, and splenomegaly occurs rarely.

ICD 10 Code:  A38.9 – Scarlet fever, uncomplicated

For more information about this quiz ― specifically, differential diagnoses and pitfalls, clinical tests, management pearls, therapy and a complete list of references ― visit VisualDx online.