Which symptom is most typical of scarlet fever?

• A. Koplik spots
• B. Bullous rash with crusting
• C. Strawberry tongue
• D. Scarlet fever

Answer: (C)

Strawberry tongue is a classic sign of scarlet fever. After a strep throat infection releases erythrogenic toxin, the oral mucosa becomes inflamed and the taste buds (fungiform papillae) swell and become more prominent. This turns the tongue bright red and bumpy, giving the appearance of a strawberry. Early in the course it may be white-coated (white strawberry tongue), but the coating peels away to reveal the vivid red surface. This distinctive tongue appearance helps set scarlet fever apart from other conditions. Koplik spots are associated with measles, not scarlet fever, and a bullous rash with crusting isn’t the typical scarlet fever presentation. The disease itself isn’t a symptom, but strawberry tongue is a characteristic sign you’d look for.