Mild forms of the illness have been referred to as "pharyngitis with a rash" or benign scarlet fever." In contrast, malignant forms are described as either septic or toxic. Septic refers to the development of local invasion of the soft tissues of the neck and complication such as upper airway obstruction, otitis media with perforation, meningitis, mastoiditis, invasion of the jugular vein or carotid artery, and bronchopneumonia. The toxic form is rare, but presents with severe sore throat, marked fever, delirium, skin rash, and painful cervical lymph nodes initially develop. These malignant forms of scarlet fever have been less common in the antimicrobial era.