Pediatric Fever with Rash: Diagnostic Guide
This comprehensive medical educational resource serves as a vital reference tool for healthcare professionals, medical students, and residents who need to understand and differentiate between various conditions that present with fever and rashes (fever-rash syndromes). The content covers a wide spectrum of conditions, from common viral exanthems to rare autoinflammatory disorders, organized in an interactive slideshow format that facilitates systematic learning and quick reference during clinical practice.
The material is particularly valuable in emergency departments, outpatient clinics, and teaching hospitals where clinicians frequently encounter patients with fever and rash combinations. Each slide provides structured information about key features, differential diagnoses, and diagnostic approaches, making it an excellent tool for both teaching purposes and clinical decision-making. The systematic presentation of multiple conditions, ranging from benign self-limiting diseases to life-threatening emergencies, helps healthcare providers develop a comprehensive approach to fever-rash presentations, ultimately leading to more accurate and timely diagnoses for their patients.
1. Measles (Rubeola)
- High fever (up to 40.5°C)
- 3 C's: Cough, Coryza, Conjunctivitis
- Koplik's spots (pathognomonic)
- Maculopapular rash: Face → trunk → extremities
- IgM antibodies
- RT-PCR from nasopharyngeal swab
- Viral culture
- Travel/exposure history crucial
2. Rubella (German Measles)
- Low-grade fever
- Lymphadenopathy (postauricular, occipital)
- Pink maculopapular rash: Face → trunk → extremities
- Milder than measles
- Rubella-specific IgM
- Rising IgG titers
- PCR from nasopharyngeal swab
- Important in pregnant contacts
3. Roseola Infantum (HHV-6)
- High fever for 3-5 days
- Rash appears as fever resolves
- Rose-pink macular rash
- Typically affects 6-24 months old
- Clinical diagnosis
- PCR for HHV-6 if needed
- Characteristic fever pattern
- Rash timing diagnostic
4. Varicella (Chickenpox)
- Moderate fever
- "Dew drops on rose petals" appearance
- Pruritic vesicular rash in different stages
- Centripetal distribution
- Clinical diagnosis usually sufficient
- Tzanck smear
- PCR from vesicular fluid
- VZV IgM/IgG
5. Hand, Foot, and Mouth Disease
- Low-grade fever
- Vesicular lesions on palms, soles
- Oral ulcers
- Usually caused by Coxsackievirus A16
- Clinical diagnosis
- PCR from vesicular fluid
- Viral culture
- Distribution pattern diagnostic
6. Erythema Infectiosum (Fifth Disease)
- Low-grade or no fever
- "Slapped cheek" appearance
- Lacy reticular rash on extremities
- Caused by Parvovirus B19
- Clinical appearance often diagnostic
- Parvovirus B19 IgM
- PCR for Parvovirus B19
- Important in pregnant contacts
7. Zika Virus Infection
- Mild fever
- Maculopapular rash
- Conjunctivitis
- Joint pain
- RT-PCR in acute phase
- Zika virus IgM
- Travel history crucial
- Consider in endemic areas
8. Dengue Fever
- High fever
- Biphasic fever pattern
- Petechial rash in recovery phase
- Severe muscle/joint pain
- NS1 antigen test
- Dengue IgM/IgG
- Complete blood count
- Monitor for warning signs
9. Chikungunya
- High fever
- Maculopapular rash
- Severe arthralgia
- Headache
- RT-PCR in early phase
- Chikungunya IgM
- Travel history
- Distinguished from dengue
10. Infectious Mononucleosis
- Fever
- Maculopapular rash (especially with ampicillin)
- Lymphadenopathy
- Pharyngitis
- Monospot test
- EBV-specific antibodies
- Complete blood count
- Liver function tests
11. Scarlet Fever
- High fever
- "Sandpaper" rash
- Strawberry tongue
- Pastia's lines in skin folds
- Associated with Group A Streptococcus
- Rapid strep test
- Throat culture
- ASO titers
- Monitor for complications
12. Meningococcemia
- High fever with rapid onset
- Petechial/purpuric rash
- Rapid progression
- Signs of meningitis
- Blood culture
- CSF analysis
- PCR for N. meningitidis
- Immediate antibiotic treatment
13. Toxic Shock Syndrome
- High fever
- Diffuse erythroderma
- Hypotension
- Multisystem involvement
- Blood cultures
- Complete metabolic panel
- Coagulation studies
- Source identification crucial
14. Staphylococcal Scalded Skin Syndrome
- Fever
- Tender erythema
- Superficial desquamation
- Nikolsky sign positive
- Clinical diagnosis
- Skin biopsy if unclear
- Blood culture
- Monitor fluid status
15. Rocky Mountain Spotted Fever
- High fever
- Maculopapular → petechial rash
- Wrists/ankles → central spread
- Headache, myalgia
- Serologic testing
- PCR from skin biopsy
- Tick exposure history
- Early treatment crucial
16. Lyme Disease
- Low-grade fever
- Erythema migrans
- Bulls-eye appearance
- Multiple lesions in disseminated disease
- Two-tier testing
- ELISA followed by Western blot
- Tick exposure history
- Geographic consideration
17. Mycoplasma Infection
- Fever
- Stevens-Johnson-like rash
- Pneumonia
- Mucositis
- PCR from throat swab
- Serology (IgM, IgG)
- Chest X-ray
- Cold agglutinins
18. Rat-Bite Fever
- Relapsing fever
- Maculopapular/petechial rash
- Arthralgia
- Exposure history
- Blood culture
- Gram stain
- Animal exposure history
- Consider in pet rat owners
19. Typhoid Fever
- Step-ladder fever pattern
- Rose spots on abdomen
- Relative bradycardia
- Hepatosplenomegaly
- Blood culture
- Widal test
- Stool culture
- Travel history important
20. Cat Scratch Disease
- Low-grade fever
- Primary inoculation lesion
- Regional lymphadenopathy
- Cat exposure history
- Bartonella henselae serology
- PCR from lymph node
- Lymph node biopsy
- Cat exposure history
21. Ehrlichiosis
- High fever
- Maculopapular rash
- Severe myalgia
- Tick exposure
- PCR testing
- Peripheral blood smear
- Serologic testing
- Monitor blood counts
22. Gonococcal Disease
- Fever
- Pustular skin lesions
- Arthritis
- Adolescent consideration
- Culture from lesions
- NAAT testing
- Joint fluid analysis
- Screen for other STIs
23. Secondary Syphilis
- Low-grade fever
- Copper-colored rash
- Palms/soles involvement
- Lymphadenopathy
- RPR/VDRL
- Treponemal tests
- Dark field microscopy
- CSF analysis if indicated
24. Relapsing Fever
- Recurring fever episodes
- Petechial rash
- Jaundice
- Tick/louse exposure
- Blood smear during fever
- PCR testing
- Exposure history
- Geographic consideration
25. Leptospirosis
- Biphasic fever
- Conjunctival suffusion
- Petechial rash
- Exposure to contaminated water
- MAT (gold standard)
- ELISA IgM
- PCR in early phase
- Liver/kidney function tests
26. Kawasaki Disease
- High fever ≥5 days
- Polymorphous rash
- Conjunctival injection
- Oral changes
- Cervical lymphadenopathy
- Extremity changes
- Clinical criteria based diagnosis
- Elevated inflammatory markers
- Echocardiogram mandatory
- Monitor for coronary aneurysms
27. Systemic Juvenile Idiopathic Arthritis
- High spiking fever
- Salmon-pink evanescent rash
- Arthritis
- Lymphadenopathy
- Ferritin levels
- Complete blood count
- Joint imaging
- Exclude infections
28. Henoch-Schönlein Purpura
- Low-grade fever
- Palpable purpura
- Abdominal pain
- Arthralgia
- Clinical diagnosis
- Skin biopsy if unclear
- Urinalysis monitoring
- Renal function tests
29. Stevens-Johnson Syndrome
- High fever
- Severe mucocutaneous involvement
- Target lesions
- Often drug-triggered
- Clinical presentation
- Skin biopsy
- Drug history crucial
- Monitor fluid/electrolytes
30. DRESS Syndrome
- High fever
- Extensive rash
- Eosinophilia
- Internal organ involvement
- RegiSCAR criteria
- Complete blood count
- Liver function tests
- Drug history essential
31. Serum Sickness
- Fever
- Urticarial rash
- Joint pain
- Following medication/antiserum
- Clinical diagnosis
- C3/C4 levels
- Drug/antiserum history
- Inflammatory markers
32. Acute Rheumatic Fever
- Fever
- Erythema marginatum
- Migratory arthritis
- Carditis
- Jones criteria
- ASO titers
- ECG/Echocardiogram
- Prior strep history
33. Sweet Syndrome
- Fever
- Tender erythematous plaques
- Neutrophilia
- Associated conditions
- Skin biopsy
- Complete blood count
- Search for underlying cause
- Inflammatory markers
34. PFAPA Syndrome
- Periodic fever
- Aphthous stomatitis
- Pharyngitis
- Cervical adenitis
- Clinical diagnosis
- Pattern recognition
- Exclusion of other causes
- Response to steroids
35. CAPS (Cryopyrin-Associated Periodic Syndromes)
- Recurrent fever
- Urticaria-like rash
- Cold-triggered symptoms
- Joint/CNS involvement
- Genetic testing (NLRP3)
- Family history
- Clinical features
- Response to IL-1 blockers
36. TRAPS (TNF Receptor Associated Periodic Syndrome)
- Prolonged fever episodes
- Migratory rash
- Periorbital edema
- Severe myalgia
- TNFRSF1A gene testing
- Inflammatory markers
- Family history
- Response to biologics
37. MIS-C (Multisystem Inflammatory Syndrome in Children)
- High fever
- Polymorphic rash
- Multi-organ dysfunction
- Post-COVID association
- CDC/WHO criteria
- SARS-CoV-2 serology
- Inflammatory markers
- Cardiac evaluation
38. Primary Hemophagocytic Lymphohistiocytosis
- Persistent fever
- Variable rash
- Hepatosplenomegaly
- Cytopenias
- HLH-2004 criteria
- Ferritin levels
- Genetic testing
- Bone marrow examination
40. Langerhans Cell Histiocytosis
- Fever
- Seborrheic-like rash
- Bone lesions
- Multi-system involvement
- Skin/bone biopsy
- CD1a/S100 staining
- Skeletal survey
- PET-CT if indicated
41. Acrodynia (Mercury Poisoning)
- Low-grade fever
- Pink, painful hands/feet
- Photosensitivity
- Hypertension
- Blood/urine mercury levels
- Environmental history
- 24-hour urine collection
- Neurological evaluation
42. Acrodermatitis Enteropathica
- Fever
- Periorificial dermatitis
- Alopecia
- Diarrhea
- Zinc levels
- Alkaline phosphatase
- Skin biopsy
- Response to zinc
43. Acute Generalized Exanthematous Pustulosis
- High fever
- Sterile pustules
- Rapid onset
- Drug association
- EuroSCAR criteria
- Skin biopsy
- Drug history
- Differentiate from pustular psoriasis
44. Erythema Multiforme
- Fever
- Target lesions
- Post-infectious/drug
- Mucosal involvement
- Clinical diagnosis
- HSV PCR if indicated
- Drug history
- Skin biopsy if atypical
45. Familial Mediterranean Fever
- Recurrent fever
- Erysipelas-like erythema
- Serositis
- Ethnic predisposition
- MEFV gene testing
- Acute phase reactants
- Family history
- Colchicine response
46. Neonatal Lupus
- Fever
- Annular lesions
- Heart block
- Maternal antibodies
- Anti-Ro/La antibodies
- ECG/echocardiogram
- Maternal history
- Skin biopsy
47. Hyperimmunoglobulin D Syndrome
- Recurrent fever
- Cervical lymphadenopathy
- Maculopapular rash
- Early onset
- MVK gene mutation
- IgD levels
- Mevalonic acid testing
- Genetic counseling
48. CANDLE Syndrome
- Recurrent fever
- Violaceous eyelid edema
- Lipodystrophy
- Growth delay
- PSMB8 gene testing
- Interferon signature
- Skin biopsy
- Metabolic evaluation
49. Schnitzler Syndrome
- Chronic fever
- Urticarial rash
- Bone pain
- Monoclonal gammopathy
- Strasbourg criteria
- Serum protein electrophoresis
- Bone scan
- IL-1 blockade response
50. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- High fever
- Extensive rash
- Facial edema
- Internal organ involvement
- RegiSCAR criteria
- Eosinophil count
- Liver function tests
- HHV-6 reactivation
51. Papular-Purpuric Gloves and Socks Syndrome
- Fever
- Edema and erythema of hands/feet
- Petechial purpura
- Parvovirus B19 association
- Clinical diagnosis
- Parvovirus B19 serology
- Complete blood count
- Self-limiting course
52. Rowell Syndrome
- Fever
- Lupus-like lesions
- Erythema multiforme-like lesions
- Chilblain-like lesions
- ANA testing
- Anti-Ro/La antibodies
- Rheumatoid factor
- Skin biopsy
53. Gianotti-Crosti Syndrome
- Low-grade fever
- Symmetric acral papules
- Lymphadenopathy
- Associated with various viruses
- Clinical diagnosis
- Viral studies if indicated
- Liver function tests
- Self-limiting course
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.