strawberry tongue Pastia lines, bright red, orange, or even hemorrhagic lines, can occasionally be seen in the axillae or antecubital fossa The rash generally lasts to days, followed by brownish discoloration and peeling of the skin as small flakes to entire casts of the digits A rapid streptococcal test or throat culture confirms infection Epstein–Barr Virus Between 5% and 15% of patients with Epstein–Barr viral infection, otherwise known as infectious mononucleosis, will have an erythematous maculopapular eruption Infection in young children is usually asymptomatic or so mild that diagnosis is not sought Older patients between 15 and 25 years of age are more likely to present for evaluation Fifty percent to 100% of patients with infectious mononucleosis develop a maculopapular rash after receiving concurrent ampicillin or amoxicillin-containing antibiotics—most commonly for an incorrect diagnosis of streptococcal pharyngitis The illness begins insidiously with headache, malaise, and fever, followed by sore throat, membranous tonsillitis, and lymphadenopathy Splenomegaly is common The exanthem occurs within to days as a macular or maculopapular morbilliform eruption most prominent on the trunk and proximal extremities An enanthem consisting of discrete petechiae at the junction of the hard and soft palate occurs in approximately 25% of patients Diagnosis is often presumed clinically but may be supported by an absolute increase in atypical lymphocytes or a positive heterophile antibody (monospot) test (obtained after the first week of symptoms), or may be confirmed by serology The heterophile antibody test is less sensitive in children younger than years of age The illness is most commonly self-limited, requiring no therapy, but due to the frequency of associated splenomegaly, affected children should not be allowed to participate in contact sports until fully recovered and the spleen is no longer palpable Mycoplasma Infections Infections with Mycoplasma pneumoniae may cause morbilliform rashes in up to 15% of cases The classic clinical presentation is of a child with malaise, lowgrade fever, and prominent cough The cough is initially nonproductive but may become productive, particularly in older children, and may persist for to weeks Physical examination may reveal bilateral rales Diagnosis is suggested by mycoplasma PCR of the sputum or by IgM or IgG titers of the blood Erythromycin, clarithromycin, or azithromycin are the