A four-year-old male with no relevant past medical history was successfully vaccinated, with fever of 38.5oC for 12 hours (h) of evolution, painful submandibular lymphadenopathy, erythematous pharynx with exudate.
In addition, the patient presented a micropapular fold raised in a "cow skin" that affected the trunk and the inguinal and axillary folds, slightly pruritic and slightly painful exanthema.
Due to the clinical suspicion of scarlet fever, a rapid test for the detection of Streptococcus pyogenes was performed, which was negative. Expectant management and clinical review were performed within 24-48 h.
At 24 h, the general condition had worsened with fever up to 39 oC and persistence of rash, so, given the high suspicion of scarlatin, it was decided to collect pharyngeal smears and administer amoxicillin once daily.
After 72 h the result of the pharyngeal smear was positive for Staphylococcus aureus (abundant growth) and sensitive to amoxicillin/clavulanic acid.
At that time, the patient is clinically well, afflicted and the rash has been diagnosed, so it was decided to complete the treatment with amoxicillin/clavulanic acid for eight days.
Two weeks after the onset of fever, the patient developed desquamation of "gloving finger" plants and palms.
