A woman with a sore throat, fever, and sweats

Short abstract

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A 32 year old woman became unwell with a three day history of a sore throat, fevers, and sweats. She had recently separated from her bisexual male partner and was taking the contraceptive pill. Her tonsillar glands were enlarged and tender, her tonsils were inflamed (Lancefield group A β‐haemolytic streptococci were subsequently isolated).

Blood tests were unremarkable save for a neutrophilia of 14, an erythrocyte sedimentation rate of 61 mm in first hour, and C reactive protein of 237. She improved with intravenous penicillin, but one week later a papular scaling rash developed (see figs 1 and 2).

Figure 1 Papular scaling rash of the trunk.

Figure 2 Papular scaling rash of the hands.

Questions

1. What is the most probable diagnosis?

2. What other diagnosis should be considered?

3. What other relevant tests should be considered?