case_images: PMC11813535_01
case_images: Clinical course of the 57-year-old woman with GABHS infection. Her clinical episode began four weeks before the first hospital visit with fever, sore throat, runny nose, arthralgia, fatigue, and widespread skin rash in the body trunk and left arm. These symptoms, except for the arthralgia, once subsided with oral loxoprofen sodium. Two weeks after this resolution, she noticed a recurrence of these symptoms. Because she experienced similar symptoms with the diagnosis of GABHS infection about 30 years before, she decided to visit our hospital to undergo the GABHS antigen rapid testing.. GABHS: Group A beta-hemolytic Streptococcus
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case_images: FIG1
case_images: Her clinical course with observed conditions and treatments is shown in Figure 1.
case_images: PMC11813535_02
case_images: PMC11813535_03
case_images: Oral ulcer and oropharyngeal finding at the first hospital visit. (A) A painful oral ulcer below the tongue (white circle) was present. (B) The oropharyngeal mucosa was slightly reddish, but there was no tonsillar swelling or exudates.
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case_images: FIG2
case_images: She had a painful oral ulcer below her tongue (Figure 2A), but her oropharyngeal findings were not so remarkable (Figure 2B).
case_images: Pruritic skin rash in the body trunk at the first hospital visit. The pruritic skin rash in her right upper back (A), left upper back (B), and middle upper back (C) are presented. These rashes or itchiness did not subside with intravenous histamine H1 receptor blockers.
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case_images: FIG3
case_images: Her pruritic skin rash in the body trunk is shown in Figure 3.
case_images: Swollen left wrist joint at the first hospital visit and resolved findings 3 days later. (A) At the first hospital visit, her left hand and wrist were swollen with slight pain (white arrowheads). (B) These findings were swiftly resolved by 3 days after starting the oral antibiotic drug.
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case_images: FIG4
case_images: She also had swelling in her left hand and wrist joint, and the swollen area was slightly painful (Figure 4A).
case_images: Resolving skin rashes and lip swelling at 3 days after starting oral antibiotics. Resolving skin rashes in her lower back (A) and anterior chest (B) after 3 days from starting oral antibiotics are shown. (C) Lip swelling was also resolving with brownish crust formation (white arrowheads).
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case_images: FIG5
case_images: After starting the antibiotics, sore throat and skin rash swiftly started to coalesce and resolve within several days (Figure 5A, 5B). The patient reported an exacerbation of lip swelling with a burning sensation after the first hospital visit, but it also gradually resolved with a brownish crust formation (Figure 5C).
case_images: Another oral ulcer and pruritic small nodules in the left hand after one month from the first hospital visit. (A) Another painful oral ulcer on the other side of the lingual frenulum below the tongue (black circle) was present one month after the first hospital visit. (B) Pruritic small skin nodules with rough, lumpy surfaces were left behind after the swelling of the left wrist joint receded.
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case_images: FIG6
case_images: This time, she had another painful oral ulcer on the other side of the lingual frenulum below the tongue (Figure 6A). She reported the presence of pruritic, painless small nodules with a rough, lumpy surface in her left hand, which became clear after the withdrawal of left wrist swelling (Figure 6B).
case_images: Echocardiogram showing possible anterior mitral leaflet calcification with mild mitral regurgitation at 4 weeks after the first hospital visit. (A) Long-axis view suggested the presence of anterior mitral leaflet calcification (white ellipse). (B) Four-chamber view. (C) Four-chamber view in color Doppler echocardiography showing the presence of mild mitral regurgitation (white ellipse).
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case_images: FIG7
case_images: A cardiac murmur was absent, but the electrocardiogram suggested the presence of anterior mitral leaflet calcification with mild mitral regurgitation (Figure 7).