Which disease is characterized by a strawberry tongue and a sandpaper-like rash following streptococcal pharyngitis?

Which disease is characterized by a strawberry tongue and a sandpaper-like rash following streptococcal pharyngitis?

• A. Measles
• B. Scarlet fever
• C. Rubella
• D. Erythema infectiosum

Answer: (B)

Scarlet fever is the clear match here. It occurs after a streptococcal throat infection when the bacteria release erythrogenic toxins that cause a diffuse, rough, sandpaper-like rash. The tongue often becomes coated and then turns bright red and swollen with visible tiny papillae, giving the characteristic strawberry tongue. The rash typically starts on the neck and trunk and then spreads to the rest of the body, and it may be more noticeable in the creases (Pastia’s lines). The other diseases listed don’t fit this combination. Measles presents with a fever, cough, coryza, and conjunctivitis plus Koplik spots and a characteristic maculopapular rash, not a sandpaper texture or strawberry tongue. Rubella has a milder, fine pink rash with tender lymphadenopathy but lacks strawberry tongue and the post-streptococcal timeline. Erythema infectiosum (fifth disease) shows a “slapped cheeks” appearance with a lacy body rash, not the sandpaper texture or strawberry tongue. So the signs—the post-streptococcal onset, the rough sandpaper-like rash, and the strawberry tongue—point to scarlet fever.

Scarlet fever is the clear match here. It occurs after a streptococcal throat infection when the bacteria release erythrogenic toxins that cause a diffuse, rough, sandpaper-like rash. The tongue often becomes coated and then turns bright red and swollen with visible tiny papillae, giving the characteristic strawberry tongue. The rash typically starts on the neck and trunk and then spreads to the rest of the body, and it may be more noticeable in the creases (Pastia’s lines).

The other diseases listed don’t fit this combination. Measles presents with a fever, cough, coryza, and conjunctivitis plus Koplik spots and a characteristic maculopapular rash, not a sandpaper texture or strawberry tongue. Rubella has a milder, fine pink rash with tender lymphadenopathy but lacks strawberry tongue and the post-streptococcal timeline. Erythema infectiosum (fifth disease) shows a “slapped cheeks” appearance with a lacy body rash, not the sandpaper texture or strawberry tongue.

So the signs—the post-streptococcal onset, the rough sandpaper-like rash, and the strawberry tongue—point to scarlet fever.