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A women with sore throat, fever, and sweats

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Q1: What is the most probable diagnosis?

The most probable diagnosis is guttate psoriasis, a characteristic rash comprising of multiple, small, scattered salmon coloured papules on the trunk and limbs. “Guttate” is Latin for raindrop. Clinically, a whitish scaling appears on psoriatic lesions when they are scratched with the end of an orange stick, the so called “candle wax sign”. This is a helpful, but not an exclusively diagnostic phenomenon. Classically guttate psoriasis develops two to three weeks after streptococcal group A, C, or G infection1 or during throat carriage, most frequently in children and adolescents.2 In one study 58% of patients with guttate psoriasis had serological evidence of recent streptococcal infection (n = 33).12 There may also be a family history of psoriasis.

Q2: What other diagnosis should be considered?

The differential diagnosis should include secondary syphilis. Pityriasis rosea might also be considered if the lesions appear to be aligned in the typical “fir …

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