July 1st 2007
An otherwise healthy 3-year-old girl was brought for evaluation of fever, sore throat, and shaking chills of 12 hours' duration. She had beefy-red, posterior oropharyngeal erythema and a scarlatiniform rash on her shoulder that had been present for a few hours. The rash faded out over her chest but reappeared in the perineum and lower abdomen. She also had vulvovaginal inflammation with surrounding erythema. The mother was surprised to see the inflammation, but in retrospect added that the child had complained of vaginal discomfort as well. A rapid antigen test for group A b-hemolytic streptococci (GABHS) from a swab of the oropharynx was positive.