Here's a picture you put up in your pediatrics office for the kids. Isn't the 7-month old panda cub cute? Note: This is a tough case, initially planned to be two parts, but it's Friday!
An 8 year old girl presents to your pediatrics clinic complaining of abrupt onset fever, sore throat, headache, abdominal pain, nausea, and vomiting. You look into her oropharynx and see this:
On exam, you also note tender and enlarged anterior cervical lymph nodes and palatal petechiae. You swab the tonsils and posterior pharynx and send it off for culture. The blood agar plate is shown below. Disc A contains bacitracin.
Oh, but there's more! The patient's mother brings her in a week later because of acute onset of tic-like movements. She also has obsessive-compulsive behaviors like counting and cleaning. On examination, you notice choreiform movements. You prescribe antibiotics and the symptoms improve.
Challenge: What is this strange movement disorder?
1. What did the patient initially present with?
2. Describe the colonies on the blood agar.
3. What laboratory tests would you send to confirm the diagnosis?
First image is in the public domain; second and third images are shown under fair use.