Scarlet fever is an infectious illness, which is caused by Streptococcus pyogenes. It causes exanthema and a characteristic tonsillopharyngitis. Its diagnosis is typically straightforward. However, due to the diverse clinical presentation of scarlet fever, one has to be cautious about atypical rash distribution that might go unrecognized or be misdiagnosed. Despite the fact that scarlet fever is primarily a pediatric illness, it can affect people of any age group. The case presented describes the clinical difficulty in the diagnosis of scarlet fever in an adult patient with atypical rash distribution involving dorsum of the hand and feet only till the level of wrists and ankles joints. A high degree of suspicion is required to diagnose this rare presentation and early treatment is essential to limit the spread of the disease.

Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors demonstrated a reduction in the risk of death and hospitalization for heart failure and major renal complications in recent clinical trials. However, real-world studies are still limited, especially in Saudi Arabia. This study aims to examine the clinical outcomes of SGLT2 inhibitors in heart failure patients regardless of diabetes status. Materials and methods: A retrospective study was conducted at a single cardiology center in Saudi Arabia. The study spanned from July 2021 to June 2022. The study included adult patients (≥18 years) diagnosed with heart failure with a prior history of using SGLT2 inhibitors for at least 3 months. Results: A total of 45 patients were included in the study. A significant difference was detected among the diabetic and non-diabetic patient groups in baseline diastolic blood pressure (DBP), baseline left ventricular ejection fraction (LVEF) and the use of diabetic medications with (p= 0.008, <0.001, 0.008), respectively. SGLT2 inhibitors use resulted in a trend toward improvements in HbA1C, LVEF and ED visits however, these findings were non-statically significant. Conclusions: This is the first protocol to report outcomes of SGLT2 inhibitors in Saudi heart failure patients regardless of diabetes status. We detected an improvement signal in HbA1C, ED visit frequency and LVEF in both diabetic and non-diabetic groups.Larger studies are warranted to further evaluate outcomes of SGLT2 inhibitors in this patient group regardless of diabetes.