Two cases of scarlet fever seen in Hong Kong

Abstract

Background: Description on the different clinical presentations of two scarlet fever patients seen in Hong Kong Aim: To alert GP colleagues on the features of scarlet fever and beware of this potentially complicated disease. Method: Case 1: A 5-years old boy presented on 11-11-2016 with a 1-day history of fever (38.5 degrees), sorethroat and non-specific abdominal pain. P/E showed a congested throat. Abdominal examination was unremarkable. The next day morning (~36 hours after the onset of fever), his temperature went down but he developed fine diffuse pink rash over his neck and upper trunk with a ‘sandpaper’ texture. Scarlet fever was suspected and confirmed by a positive throat swab of Streptococcus pyogenes. His rash disappeared totally 1 week later. Case 2: A 7 years-old girl presented on 21-2-2017 morning with fever (38.8 degrees) and sorethroat. P/E showed a congested throat. Her fever subsided the next day with sorethroat improved. On 23 February morning, she developed minimal faint rash over her upper trunk. She re-kicked up a low-grade fever that afternoon. The rash spread over the whole-body with a suntan appearance. Scarlet fever confirmed. The rash gradually scaled off within 1 week. Result: Both kids were cured with a 10 days’ course of oral penicillin without other long-term sequelae. Although both of them had scarlet fever, but the presentations, especially the rash onset time and morphology, were different. A high index of suspicion is the key to diagnosis. Conclusion: Scarlet fever is a notifiable disease in Hong Kong. If left untreated, it can lead to serious complications. Inadequate treatment to Streptococcus pyogenes infection is an important cause of acute rheumatic fever and rheumatic heart disease. Prompt diagnosis and ensuring patient’s drug compliance can effectively reduce complications development.