ACUTE GUTTATE PSORIASIS AFTER STREPTOCOCCAL SCARLET FEVER

A 7-year-old girl was seen in the outpatient clinic with classic features of scarlet fever (sore throat, fever, widespread sandpaper-like rash, erythema and edema of the pharynx and tonsils). Group A p-hemolytic streptococci (GAS) were cultured from throat swab, and the child was treated with penicillin V 50,000 IU/kg/day for 10 days. Three weeks later an erythematous, papulosquamous, guttate, psoriasiform eruption involving various parts of the trunk and extremities appeared. The patient had no history of psoriasis. Throat culture again grew GAS, and the acute antistreptolysin O (ASO) and antideoxyribonuclease B (anti-DNase B) titers were, respectively, 393 and 640 IU/ml. The child was prescribed amoxycillin plus clavulanate 50 mg/kg/day for 10 days; an additional 10-day course of the drugs was required to eliminate symptoms and eradicate the organism. The psoriatic skin changes cleared 30 days after the institution of therapy. The convalescent ASO and anti-DNase B titers were, respectively, 1030 and 2560 IU/ml.