Doughnut” Lesions

An otherwise healthy 9-year-old girl presented to the primary care clinic with a sore throat and fever. Her temperature was 38.5°C. Physical examination revealed swollen and tender cervical lymph nodes, an inflamed uvula, enlarged tonsils, and “doughnut” lesions on both the hard and soft palates (Panels A and B). A rapid antigen detection test for group A streptococcus was positive. Throat culture confirmed group A beta-hemolytic streptococcus. “Doughnut” lesions are erythematous papules with a pale center that may be present on both the soft and hard palates. The presence of these lesions is a clinical sign that has historically been associated with group A streptococcus pharyngitis. The patient was treated with a 10-day course of oral amoxicillin and recovered without complication.