Photo Rounds

Papillae on tongue

A 5-year-old girl was brought to the family physician (FP)’s office with a fever and a sore throat. The girl had a temperature of 102.4°F and a red tongue with prominent papillae. The posterior pharynx was also erythematous with slight exudate visible. The anterior cervical lymph nodes were mildly tender and somewhat enlarged. There were no rashes noted.

What's your diagnosis?


The child had a strawberry tongue and scarlet fever caused by strep pharyngitis. The tongue had prominent papillae along with erythema, making it resemble a strawberry. Strawberry tongue is most commonly seen in children with scarlet fever or Kawasaki disease. Strawberry tongue usually develops within the first 2 to 3 days of illness. A white or yellowish coating usually precedes the classic red tongue with white papillae.

In this case, the FP explained the diagnosis to the mother and prescribed oral penicillin VK. She also recommended ibuprofen for the fever and sore throat. The girl felt somewhat better by the next day, and the mother continued to give the penicillin for the full 10 days as directed to prevent rheumatic fever.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Sanders MJ, French L. Scarlet fever and strawberry tongue. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:208-212.

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