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  • Snapshot
    • A 5-year-old boy presents to the emergency room with a rash. He has had a sore throat with fever for 2 days now. On physical exam, he has a diffuse erythematous sandpaper-like rash that blanches with pressure. His tongue is beefy-red. A rapid strep test was positive. As he is documented to be allergic to penicillin, he is prescribed cephalexin.
  • Introduction
    • Clinical definition
      • acute bacterial infection with diffuse erythematous eruption associated with pharyngitis
    • Epidemiology
      • demographics
        • children
      • risk factors
        • exposure to Streptococcus pyogenes or other erythrogenic strains
    • Pathogenesis
      • delayed-type hypersensitivity to S. pyogenes exotoxin A
    • Associated conditions
      • streptococcal pharyngitis
    • Prognosis
      • rash usually fades within a week
      • desquamation may last several weeks
  • Presentation
    • Symptoms
      • sore throat
      • fever
    • Physical exam
      • strawberry tongue
      • circumoral pallor
      • diffuse blanching erythema
      • sandpaper-like rash with small papules
        • spreads from the groin and armpits and to the trunk and extremities
        • spares the palms and soles
      • the rash is followed by desquamation
  • Studies
    • Labs
      • rapid streptococcal testing
      • throat culture may reveal streptococcal pharyngitis
    • Making the diagnosis
      • based on clinical presentation
  • Differential
    • Kawasaki disease
      • distinguishing factors
        • hand and foot rash
        • prolonged fever
        • conjunctival injection
        • no association with streptococcal pharyngitis
    • Staphylococcal scalded skin syndrome
      • distinguishing factors
        • + Nikolsky sign
  • Treatment
    • Management approach
      • identical to the treatment approach in patients with streptococcal pharyngitis
      • additional treatment for the rash is not needed
    • Medical
      • penicillin
        • indications
          • for all patients
          • prevention of acute rheumatic fever
        • drugs
          • penicillin V
          • amoxicillin
      • alternatives to penicillin
        • indications
          • for patients with penicillin allergies
          • prevention of acute rheumatic fever
        • drugs
          • cephalosporins
          • clindamycin
          • macrolides
  • Complications
    • Acute rheumatic fever or rheumatic heart disease
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