Strawberry Tongue in Streptococcal Pharyngitis

A 5-year-old girl presented to the pediatric clinic with a 3-day history of fever, sore throat, and pain with swallowing. She had no associated cough, rhinorrhea, or hoarseness. The temperature was 40°C. On examination, she appeared to be ill, with dry mucous membranes and tender anterior cervical lymphadenopathy. She had fissured lips and a red tongue with enlarged papillae, an appearance referred to as a strawberry tongue. The tonsils were enlarged and edematous with exudates. She had no rash, conjunctival congestion, oral ulcers, or splenomegaly. Laboratory studies showed a total leukocyte count of 14,400 cells with 73.0% neutrophils, 19.0% lymphocytes, and 0.9% atypical lymphocytes. The throat culture was positive for group A streptococcus, and a diagnosis of streptococcal pharyngitis was made. A strawberry tongue can also be present in other conditions, including Kawasaki’s disease. She received treatment with oral amoxicillin for 10 days and had a complete recovery. She had no recurrence of symptoms at follow-up 3 and 6 months later.

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