Strep Throat and Rash: Typical Presentation and Differential
Streptococcal pharyngitis (Group A Strep) presents with:
- Sudden sore throat, odynophagia.
- Fever >38.3°C.
- Tonsillar exudates, petechiae on palate.
- Anterior cervical lymphadenopathy.
- Absence of cough, rhinorrhea, hoarseness (suggests viral).
A rash on the buttocks/perineum is not typical. Consider:
- Scarlet fever (sandpaper rash on trunk, flexures, face—circumoral pallor, strawberry tongue).
- Viral exanthems (EBV, adenovirus, enterovirus).
- Drug eruption (if antibiotics started).
- Diaper/contact dermatitis (infants).
Confirm with rapid antigen test or throat culture. Treat with penicillin/amoxicillin × 10 days to prevent rheumatic fever.
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