A three-year-old girl, with no personal or family history of interest, was referred by her pediatrician to the allergy department for presenting, for one year, recurrent episodes of disseminated habomatous lesions.
The sprouts appeared every one or two months, frequently occurring within a week and sometimes accompanied by odynophagia.
Parents did not relate these conditions with any possible triggering external agent, including drugs or food.
Physical examination performed during the first visit revealed hypertrophy of the palatine tonsils, with no other remarkable findings.
Skin prick tests with a standard pneumal batteries were common negative in the region (including dust mites, pollen, animal epithelia, latex, food and simple panisakis).
The general laboratory tests (biochemistry, blood count, erythrocyte sedimentation rate, thyroid hormones and urine) were normal, as well as serum immunoglobulins IgA, IgM and IgG classes.
The total IgE level was 104.5 IU/ml (normal reference values, 100-120 IU/ml).
Antistreptococcal antibody levels were 1571 IU/ml (laboratory reference value, 0-200 IU/ml).
The stool examination did not show signs of infection.
After the introduction of intramuscular penicillin G-benzatin for four months (one dose per month), the girl was asymptomatic, and a progressive decrease in ASLO levels was observed until her normalization.
