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Scarlet fever — DCH MCQ

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EasyCommon childhood illnessesScarlet feverDCH

A 6-year-old girl presents with sore throat, fever, a sandpaper-textured rash and flushed cheeks with circumoral pallor. Her tongue is erythematous and bumpy, and she has tender cervical lymphadenopathy. What is the most likely diagnosis?

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Correct answer: C — Scarlet fever

The correct answer is C, scarlet fever. The combination of acute fever and pharyngitis with a fine sandpaper-textured rash, flushed cheeks with circumoral pallor, tender cervical nodes and a strawberry tongue is characteristic. Kawasaki disease can also cause fever, rash and a strawberry tongue, but typically involves fever lasting at least 5 days with features such as bilateral conjunctival injection, cracked lips or peripheral limb changes. Measles usually has cough, coryza and conjunctivitis before a blotchy rash beginning on the face. Infectious mononucleosis more often causes marked fatigue and is commoner in adolescents, while hand, foot and mouth disease causes oral ulcers with lesions on the hands and feet.

Reference: UK Health Security Agency. Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings, section 4.1: Signs and symptoms. January 2023. https://assets.publishing.service.gov.uk/media/6426e4f1fbe620000c17da7e/guidelines-for-public-health-management-scarlet-fever-outbreaks-january-2023_.pdf