When a young girl presented to a paediatric clinic with a bumpy, swollen tongue, it sowed the seeds of suspicion for a bacterial infection.

The five-year-old had a three-day history of fever, sore throat and painful swallowing.

On examination, doctors noted dry mucous membranes, anterior cervical lymphadenopathy and oedematous tonsils with exudate.

The patient’s lips were cracked, and her tongue was red with prominent papillae — a symptom known as strawberry tongue.