A three-year-old girl, with no personal or family history of interest, was referred by her paediatrician to the Allergology Department for presenting, for the last year, recurrent episodes of disseminated habonosis lesions without angioedema. The outbreaks appeared every one or two months, usually persisted for a week and were sometimes accompanied by odynophagia. The parents did not associate these symptoms with any possible external triggering agent, including drugs or food.
Physical examination at the first visit revealed hypertrophy of the palatine tonsils, with no other noteworthy findings.
Skin tests with a standard battery of pneumoallergens common in the region (including dust mites, pollens, fungi and animal epithelia), latex, food, plant panallergens and Anisakis simplex were negative.
General laboratory tests (biochemistry, haemogram, erythrocyte sedimentation rate, thyroid hormones and urine) were normal, as were serum immunoglobulin classes IgA, IgM and IgG. Total IgE was 104.5 IU/ml (normal reference values 100-120 IU/ml). Anti-streptolysin O antibody (ASLO) levels were 1571 IU/ml (laboratory reference value, 0-200 IU/ml). No parasites were observed in the stool examination.
After treatment with penicillin G-benzathine intramuscularly for four months (one dose per month), the child was asymptomatic and ASLO levels progressively decreased to normal.