SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Simultaneous Streptococcal Pharyngitis and Facial Erysipelas.

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An 86-year-old woman with well-compensated cirrhosis from primary biliary cholangitis developed 2 days of sore throat, fever, nasal congestion, and then a rapidly spreading, painful malar facial rash. Exam showed fever, pharyngeal erythema without exudate, tender cervical lymphadenopathy, and a sharply demarcated, warm erythematous “butterfly” plaque involving the nasal folds, consistent with facial erysipelas.  <br /><br />Workup showed a normal WBC count with neutrophil predominance, negative blood cultures, and negative MRSA, flu/COVID, and respiratory viral testing. A rapid strep test from a nasopharyngeal/pharyngeal specimen was positive for group A Streptococcus (GAS). The team believed this single positive throat specimen supported microbiologic confirmation of both simultaneous streptococcal pharyngitis and facial erysipelas caused by the same organism.  <br /><br />Because of the rapid spread of the rash, she was admitted and started on IV ceftriaxone and vancomycin. After MRSA testing was negative, vancomycin was stopped. Her throat pain and facial erysipelas improved with treatment, and she was discharged on oral cephalexin.  <br /><br />The case highlights that GAS can cause infections at multiple sites and that a throat swab may indirectly identify the likely pathogen responsible for a concurrent skin infection. The authors describe this as a rare example of simultaneous microbiologically confirmed streptococcal pharyngitis and facial erysipelas.

Asset Subtitle

Katsiaryna Murashka

Meta Tag

Author List David Bekhor, Katsiaryna Murashka, Violetta Laskova

Category Clinical Vignettes

Concept Facial Erysipelas

Concept Group A Streptococcal Pharyngitis

Concept Group A Streptococcus

Concept Erythematous Rash

Concept Intravenous Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, New York

Presenting Author Katsiaryna Murashka

Track Adult

Keywords

group A Streptococcus

streptococcal pharyngitis

facial erysipelas

butterfly rash

primary biliary cholangitis

cirrhosis

rapid strep test

cervical lymphadenopathy

ceftriaxone

cephalexin

Facial Erysipelas

Group A Streptococcal Pharyngitis

Group A Streptococcus

Erythematous Rash

Intravenous Antibiotic Therapy