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Scarlet fever — RACP Paediatrics MCQ

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EasyIDScarlet feverRACP Paediatrics

A 5-year-old presents with fever, sore throat, and a confluent sandpaper-textured erythematous rash with perioral pallor. The tongue has a white coating that peels to reveal a red strawberry appearance. There is tender cervical lymphadenopathy. What is the most likely diagnosis?

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Correct answer: D — Scarlet fever

Sandpaper-textured rash with perioral pallor, strawberry tongue, and pharyngitis/tonsillitis is characteristic of scarlet fever (group A streptococcal infection). Treatment is with oral phenoxymethylpenicillin (penicillin V) for 10 days. Pastia lines (linear petechiae in skin folds) may also be present.

Reference: RCH Melbourne – 2023 – Rash and Fever CPG; Australian Therapeutic Guidelines – 2024 – Antibiotic