Sore throat is considered a seasonal disease by a majority of us. Mostly, mild soreness takes its time and fades away, while moderate to severe ones require treatment with antibiotics.
But can sore throat have long term complications?
Can sore throat lead to another condition even after its resolved?
A 47-year-old man was diagnosed with pharyngitis when he complained of sore throat and fever for which he was started on penicillin V potassium. A week later, he presented to the emergency department with complaints of pustular rashes on both of his hands.
Given his history of pharyngitis, a throat swab was taken to detect the organism. The culture grew group A β-hemolytic streptococcus.
On examination, the palms of the hands and the soles, bilaterally, had multiple pustules surrounded by an erythema. The rest of the examination was normal. The joint examination was also unremarkable.
Serology revealed an absolute neutrophil count of 14,900 per cubic millimeter and a C-reactive protein level of 30 mg per liter. Renal function test was normal.
Histopathological evaluation of the punch biopsy of a palmar lesion showed a subcorneal pustule and mononuclear-cell infiltrates in the dermis.
A diagnosis of post-streptococcal pustulosis was made.
Treatment with topical clobetasol was initiated. The rash resolved in 14 days. At 1-year follow-up, the patient had no recurrence of the rash or any long term complications of streptococcal pharyngitis.
Poststreptococcal pustulosis is quite a rare postinfectious disorder secondary to streptococcal pharyngitis. Its rarity can be advocated by the fact that only 25 cases have been reported worldwide.
Although it can involve the whole body, it typically starts with a bilateral and symmetric eruption of pustules predominantly on the hands and feet with high leukocyte count and elevated C-reactive proteins and other acute-phase reactants. Other complications of post-streptococcal pharyngitis may include arthropathy and glomerulonephritis.
Poststreptococcal pustulosis resembles palmoplantar psoriasis, acute generalized exanthematous pustulosis, pustular psoriasis, pustular vasculitis, and subcorneal pustular dermatosis; therefore, high chances of a misdiagnosis.
Correct diagnosis and early treatment are imperative to avoid any long term complications.
Tal Goldberger, M. a.-P. (2020, August 20). Poststreptococcal Pustulosis. Retrieved from The New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/NEJMicm2002486
Auer-Grumbach P, Pfaffenthaler E, Soyer HP. Pustulosis acuta generalisata is a post-streptococcal disease and is distinct from acute generalized exanthematous pustulosis. Br J Dermatol. 1995;133(1):135-139. doi:10.1111/j.1365-2133.1995.tb02508.x
Fleming P, Shaw JC. Cyclosporine in the Management of Poststreptococcal Pustulosis. JAMA Dermatol. 2015;151(3):345–346. doi:10.1001/jamadermatol.2014.3517