Scarlet Fever – a Diagnostic Challenge for Physicians: a Case Report of Scarlet Fever, Hepatitis, and Sepsis in a 15 –year and 6 month– old Female Adolescent with Severe Acute Malnutrition


A Noor Fadli Idrus
Ninny Meutia Pelupessy
Husein Albar


Scarlet fever is a term used for an infection caused by a Group a Streptococcal bacteria. The early treatment of scarlet fever is strongly essential either to prevent further spreading of infection or to prevent the risk of complications consisting of peritonsillar and retropharyngeal abscess, sepsis, hepatitis, acute rheumatic fever, glomerulonephritis, pneumonia, endocarditis, and meningitis.

We present a case of scarlet fever with sepsis, hepatitis, and severe acute malnutrition in a 15 year and 6 months old female adolescent. Since the patient had specific clinical features of scarlet fever with continuous fever, sore throat, and productive cough for 4 days, followed by general red maculopapular rash initially from the head and progressively spreading to the rest of her body. The patient was also diagnosed with sepsis, hepatitis, and severe acute malnutrition. Erythromycin, ursodeoxycholic acid, vitamin C, folic acid, and vitamin b complex were given to the patient.

Rapid diagnosis and prompt treatment are important to prevent other potential complications such as sepsis, abscess, and acute rheumatic fever.  Early diagnosis of scarlet fever simultaneously with adequate treatment will prevent the complications of the disease and its spreading among other children



1. Wessels MR. Pharyngitis and Scarlet Fever. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes : Basic Biology to Clinical Manifestations. Oklahoma City (OK); 2016.
2. Lu Q, Wu H, Ding Z, Wu C, Lin J. Analysis of Epidemiological Characteristics of Scarlet Fever in Zhejiang Province, China, 2004-2018. Int J Environ Res Public Health. 2019 Sep;16(18).
3. Ben Zakour NL, Davies MR, You Y, Chen JHK, Forde BM, Stanton-Cook M, et al. Transfer of scarlet fever-associated elements into the group A Streptococcus M1T1 clone. Sci Rep [Internet]. 2015;5(1):15877. Available from:
4. Basetti S, Hodgson J, Rawson TM, Majeed A. Scarlet fever: a guide for general practitioners. London J Prim Care (Abingdon) [Internet]. 2017 Aug 11;9(5):77–9. Available from:
5. Sayers DR, Bova ML, Clark LL. Brief report: Diagnoses of scarlet fever in Military Health System (MHS) beneficiaries under 17 years of age across the MHS and in England, 2013-2018. MSMR. 2020 Feb;27(2):26–8.
6. Huang Y, Wen Y, Jia Q, Wang L, Cheng Q, Liu W, et al. Genome analysis of a multidrug-resistant Streptococcus sanguis isolated from a throat swab of a child with scarlet fever. J Glob Antimicrob Resist. 2020 Mar;20:1–3.
7. Muzumdar S, Rothe MJ, Grant-Kels JM. The rash with maculopapules and fever in children. Clin Dermatol. 2019;37(2):119–28.
8. Turner CE, Pyzio M, Song B, Lamagni T, Meltzer M, Chow JY, et al. Scarlet Fever Upsurge in England and Molecular-Genetic Analysis in North-West London, 2014. Emerg Infect Dis. 2016 Jun;22(6):1075–8.
9. Wong SSY, Yuen KY. Streptococcus pyogenes and re-emergence of scarlet fever as a public health problem. Emerg Microbes Infect [Internet]. 2012;1. Available from:
10. Wang LY, Young T-H. Hepatitis, gallbladder hydrops, splenomegaly, and ascites in a child with scarlet fever. Pediatr Emerg Care. 2012 Nov;28(11):1215–7.
11. Bhutta ZA, Berkley JA, Bandsma RHJ, Kerac M, Trehan I, Briend A. Severe childhood malnutrition. Nat Rev Dis Prim. 2017 Sep;3:17067.
12. Department of Nutrition for Health and Development World Health Organization. Global Nutrition Targets 2025 Stunting Policy Brief. World Health organization. 2014.
13. Titi-Lartey OA, Gupta V. Marasmus [Internet]. StatPearls. 2020 [cited 2021 Aug 23]. Available from:
14. Son MBF, Newburger JW. Kawasaki disease. Pediatr Rev. 2013 Apr;34(4):151–62.
15. Fimbers AM, Shulman ST. Kawasaki Disease. Pediatr Rev. 2008;29(9):308–16.
16. Gidaris D, Zafeiriou D, Mavridis P, Gombakis N. Scarlet Fever and hepatitis: a case report. Hippokratia. 2008;12(3):186–7.
17. Mena MB, Dedefo MG, Billoro BB. Treatment Outcome of Severe Acute Malnutrition and Its Determinants among Pediatric Patients in West Ethiopia. Int J Pediatr. 2018;2018:8686501.
18. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet (London, England). 2008 Jan;371(9608):243–60.
19. Jamro B, Junejo AA, Lal S, Bouk GR, Jamro S. Risk Factors for Severe Acute Malnutrition in Children under the Age of Five Year in Sukkur. Pakistan Journal of Medical Research. 2012;51(4):111–3.
20. Ashworth A. Efficacy and effectiveness of community-based treatment of severe malnutrition. Food Nutr Bull. 2006 Sep;27(3 Suppl):S24-48.
21. Akhter S, Ahmed T, Sarker SA, Sarmin M, Shahid ASMSB, Shahunja KM, et al. Factors Associated with Klebsiella Bacteremia and Its Outcome in Under-Five Children Admitted with Diarrhea. Int J Pediatr. 2016;2016:4760610.
22. Curtis BSM, Curtis SM. Nutrition and Scarlet Fever Mortality during the Epidemics of 1860 – 90 : The Sundsvall Region. Social History of Medicine 2004;17(2):199–221.
23. Herdman MT, Cordery R, Karo B, Purba AK, Begum L, Lamagni T, et al. Clinical management and impact of scarlet fever in the modern era : findings sectional study of cases in from a cross- ­ London , 2018 – 2019. BMJ Open 2021;1–9.