Palatal Petechiae in a Young Girl: What Cause?

Diffuse pinhead and petechial lesions of 1 to 2 days’ duration were noted on the palate of a 5-year-old girl. The child had a fever and sore throat with exudative tonsillitis and cervical adenitis. Results of a rapid antigen test for group A were positive. Throat culture grew group A β-hemolytic streptococci. The mere isolation of Streptococcus from a throat specimen of a child with exudative tonsillitis does not establish streptococcal infection as the cause. However, when palatal petechiae are present along with exudative tonsillitis and cervical adenitis, and a positive test or culture result, the diagnosis is more secure.

Robert P. Blereau, MD, of Morgan City, La, writes that although palatal petechiae are seen with streptococcal tonsillitis, they are not pathognomonic. These hemorrhagic spots may also accompany infectious mononucleosis, rubella (Forschheimer spots), roseola, viral hemorrhagic fevers, thrombocytopenia, and palatal trauma. In the setting of acute tonsillitis, treatment is recommended for all children who are antigen- or culture-positive for group A β-hemolytic Streptococcus. This patient responded promptly to oral penicillin.