Differential Diagnosis for Strawberry Tongue

• Single most likely diagnosis
  • Scarlet Fever: This condition, caused by Group A beta-hemolytic streptococci, is characterized by a strawberry tongue, among other symptoms like a rash and fever. The tongue's appearance is due to the enlargement of the papillae, giving it a swollen, red look.
• Other Likely diagnoses
  • Kawasaki Disease: An acute febrile illness of childhood, Kawasaki disease can present with a strawberry tongue, along with other criteria such as fever, rash, conjunctivitis, and cervical lymphadenopathy.
  • Toxic Shock Syndrome: Though less common, toxic shock syndrome can cause a strawberry tongue due to the systemic effects of the toxins produced by bacteria like Staphylococcus aureus or Streptococcus pyogenes.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: These are severe skin and mucous membrane disorders, usually a reaction to medication or infection. A strawberry tongue could be an early sign, and prompt recognition is crucial due to the high morbidity and mortality associated with these conditions.
• Rare diagnoses
  • Vitamin Deficiencies: Certain vitamin deficiencies, such as those of vitamin B12 or folate, can lead to changes in the tongue's appearance, including a condition that might resemble a strawberry tongue, though this is less common and typically accompanied by other systemic signs of deficiency.
  • Geographic Tongue: While not typically presenting as a strawberry tongue, geographic tongue can cause changes in the tongue's surface, including redness and the appearance of lesions, which might be confused with a strawberry tongue in some cases.