Snapshot A young child is brought to the pediatrician by his mother who reports that the boy has had a "sore throat" for two weeks and has recently developed a red flush in the skin with a bright red tongue. He is increasingly agitated and the rash appears to be spreading to his trunk. Introduction Infection caused by untreated Streptococcus pyogenes-related pharyngitis must have erythrogenic toxin Characterized by classic findings including strawberry tongue and desquamating rash Presentation Symptoms fever chills delirium sore throat strawberry tongue truncal rash Physical exam "beefy red" pharynx rash often described as "sunburn with goosebumps" finely-punctate, erythematous lesions that blanch with pressure initially on trunk, spreads outward within hours most intense in creases of axilla and groin eventual desquamation of hands and feet usually when fever clears Evaluation Diagnosis is based primarily on clinical evaluation, history, and physical exam Blood and/or throat cultures may show S. pyogenes Differential Kawasaki's syndrome must be ruled out; other desquamating rash disorders, including some viral exanthems seen in childhood Treatment Medical management oral penicillin indicated in all cases, except those with penicillin allergy, for which a appropriate antibiotic subsitute is prescribed Prognosis, Prevention, and Complications Prognosis very good to excellent if identified and treated early Prevention appropriate treatment of streptococcal pharyngitis will prevent progression to scarlet fever Complications glomerulonephritis and rheumatic fever