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 40ยฐC. 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 Kawasakiโs 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.