Bumpy Strawberry Tongue … Differentials?

strawberry tongue

A 5-year-old girl presented with a sore throat, fever, and a strawberry tongue. The paediatrician diagnosed streptococcal pharyngitis

Parents brought their 5-year-old girl to the outpatient department of paediatrics with complaints of fever, sore throat, and odynophagia (pain on swallowing) for the past 3 days. However, the patient did not have any associated cough, runny nose, or hoarseness. The paediatrician observed strawberry tongue on examination.

Physical examination revealed a generally ill girl with a body temperature of 40°C. Moreover, she had dry mucous membranes, fissured lips, a red tongue with enlarged papillae, enlarged and edematous tonsils with exudates. Additionally, she had tender anterior cervical lymphadenopathy.

However, the girl had no rash, conjunctival congestion, oral ulcers, or splenomegaly.

Serological investigations revealed a white blood cell count of 14,400 with 73.0% neutrophils, 19.0% lymphocytes. Additionally, it also showed 0.9% atypical lymphocytes.

The throat culture grew group A streptococcus; therefore, the pediatrician confirmed the diagnosis of streptococcal Pharyngitis.

Since the strawberry tongue is a manifestation of other conditions, including Kawasaki disease, allergies, drug-induced, toxic shock syndrome, B12 deficiency, etc.; therefore, it is imperative to take a thorough history, physical examination and perform appropriate investigations to rule out other causes of strawberry tongue.

Group A Streptococcal Pharyngitis (GAS), in most patients, is self-limited with symptoms resolving within 5 to 7 days. Moreover, antibiotics reduce the duration and severity of symptoms and prevent the spread of the infection. However, some complications can arise secondary to a GAS infection, which include:

  • Acute rheumatic fever (ARF)
  • Acute glomerulonephritis
  • Scarlet Fever
  • Poststreptococcal arthritis (PSRA)
  • Streptoccal toxic shock syndrome
  • Peritonsillar abscess
  • Retropharyngeal abscess
  • Mastoiditis
  • Otitis Media
  • Sinusitis
  • Necrotizing fasciitis
  • Streptococcal bacteremia
  • Meningitis

The paediatrician treated the girl with oral amoxicillin for 10 days. At the post-treatment follow-up, the patient had recovered completely. Similarly, she had no recurrence of symptoms at the 3- and 6-month follow-up.


Monalisa Sahu, M. B. (2021, March 25). Strawberry Tongue in Streptococcal Pharyngitis. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm2026930

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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