Pathophysiology
- Cause: Group A beta-hemolytic streptococcal (GAS) infection, typically Streptococcal Pharyngitis
- Mechanism: Some GAS strains produce streptococcal pyrogenic exotoxin
- Susceptibility: Patients with hypersensitivity to the toxin may develop a rash
Epidemiology
- Occurs in 10% of Streptococcal Pharyngitis cases
Symptoms
- Fever:
- Peaks on Day 2
- Returns to normal on Day 5-7
- Chills
- Headache
- Vomiting
- Pharyngitis
Signs
- Facial Appearance:
- Flushed forehead and cheeks
- Circumoral pallor
- Throat:
- Pharyngitis
- Hyperemic and edematous tonsils with exudate
- Inflamed throat covered by a membrane
- Possible palatal petechiae
- Tongue:
- Strawberry tongue
- Fine papules on tongue surface
- Dorsum of tongue may have white exudate and projecting edematous papillae
- Rash:
- Onset within 12-72 hours after fever
- Coalescing, blanching erythematous macules (may appear sunburn-like)
- Fine papular or punctate lesions, with texture like coarse sandpaper
- Distribution:
- Starts on the upper trunk
- Generalizes within 24 hours
- Affects flexor creases (Pastia lines) in the axillae, groin, and neck (do not blanche)
- Spares the palms and soles
- Desquamation (peeling) of palms and soles may occur
- Desquamation:
- Follows rash fading after several weeks
- Affects face, skin folds, hands, and feet
- May last up to 6 weeks
Labs
- Streptococcal Rapid Antigen Test
- Throat Culture:
- Used to confirm a negative rapid antigen test
- Antistreptolysin O Titer (ASO Titer):
- Confirms diagnosis but not typically helpful in acute disease
Differential Diagnosis
- Staphylococcal Scalded Skin Syndrome
- Kawasaki Disease:
- Also with desquamation of palms and soles as well as strawberry tongue
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