Two 4-year-old patients were admitted to the hospital with scarlet fever. Patient 1 presented with a high fever, rash spreading from face to entire body, and sore throat. Patient 2 presented with fever, rash spreading from face to chest and neck, loss of appetite, and vomiting. Both patients showed symptoms of reddened cheeks, small red rashes, crimson lips, and reddened tongue. Laboratory tests found abnormalities in blood counts. Both patients were treated with antibiotics and fever reducers.

1. Scarlet Fever

2. Case
Patient no. 1
Oyugerel a 4 year old girl
was brought in on
ambulance with a high fever
and rashes spreading from
face throughout the entire
body. The throat showed
the symptoms of soreness
and pain.
Patient no. 2
Batdorj is a 4 year old boy
was brought in by
ambulance with the
complaint of fever, rashes
spreading from face to
chest and neck. Showed
additional symptoms of
losing an appetite and
vomiting a day prior.

3. Additional information
• G. Oyugerel
• 4 years old
• Does not attend
kindergarten
• Was admitted on
19.03.15 17:15
• B. Batdorj
• 4 years old
• Goes to kindergarten
• Was admitted on
13.03.15 16:00
• Has tonsillitis

4. Physical Examination Findings
• Respiratory rate 26/min
• Heart rate 96/min
• Reddened cheeks
• Small, spotted blot like, red
rashes on the face, neck, trunk
and extremities
• Rashes were itchy
• Crimson lips
• Circumorial pallor
• Reddened tongue and tonsils
• Coating on the tongue which
disappeared after a day of
treatment
• Started with the fever of 39.5° C
• Respiratory rate 20/min
• Heart rate 88/min
• Reddened cheeks
• Small, blot like, multiple red
rashes on face, and entire body
• Circumorial pallor
• The rashes are rough on the
touch
• Rashes were itchy
• Reddened tongue
• A fever of 38.9° C prior to the
admittance

5. Progression
18.03.15 – faint red marks on the neck
19.03.15 morning – fever reached 39.5°
C, red rashes starting from the neck
(there’s a blood from scratching)
19.03.15 17:15 – admitted into the
hospital
19.03.15 evening – entire body is
covered in the rashes
19-20.03.15 – the coating on the tongue
fades after the treatment
18-22.03.15 – the fever of 38° C persists
through the nights
20-22.03.15 - rashes begin to disappear
by peeling off of the skin
(desquamation)
22.03.15 afternoon – a slight soreness in
the mouth still remains
11.03.15 evening – fever of 38.9° C,
vomiting, headache
12.03.15 afternoon – face redness,
rashes begin to spread down neck to
the chest and entire body, tongue is
red. Ambulance.
13.03.15 – admitted into hospital
17-18.03.15 – the rash begins to lessen
and thin (desquamation, starting
from the fingertips)
19-20.03.15 – lessens further
21-22.03.15 - the rash is gone but the
skin of the leg still remains a bit
rough (like a sandpaper)

6. Laboratory Testing
SG 1.015 1.015
PH 5 5
LEU 500/µl 3+
NIT Neg Neg
PRO 25 mg/dl 1+
GLU Norm Neg
KET 50 mg/dl 3+
UBG Norm Neg
BIL Neg Neg
ERY 10/µl 1+
Color Yellow
Clarity clear

7. Laboratory Testing (changes)
HCT 31.3 35.0-55.0
MPV 7.2 8.0-11.0
WBC 25.4 3.5-10.0
HGB 10.8 11.5-16.5
GRAN 23.7 1.2-8.0
LYM% 4.4 15.0-50.0
GRA% 93.2 35.0-80.0
RDW% 17.0 11.0-16.0
MPV 6.7 7.0-11.0
WBC 11.1 3.5-10.0
GRAN 8.3 1.2-8.0

8. Treatment
• Ampicillin injections
• Nurofeni
• Chlorphenamini
• Ascorutini
• Viferoni
(suppositorium)
• Tamedini
• Paracetamol
• Ampicillin injections
• Chlorphenamini
• Groprinosini
• Ascorutini
• Tamedini