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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)

Category: Viral Exanthem
Key Features:
  • High fever (up to 40.5°C)
  • 3 C's: Cough, Coryza, Conjunctivitis
  • Koplik's spots (pathognomonic)
  • Maculopapular rash: Face → trunk → extremities
Diagnostic Points:
  • IgM antibodies
  • RT-PCR from nasopharyngeal swab
  • Viral culture
  • Travel/exposure history crucial

2. Rubella (German Measles)

Category: Viral Exanthem
Key Features:
  • Low-grade fever
  • Lymphadenopathy (postauricular, occipital)
  • Pink maculopapular rash: Face → trunk → extremities
  • Milder than measles
Diagnostic Points:
  • Rubella-specific IgM
  • Rising IgG titers
  • PCR from nasopharyngeal swab
  • Important in pregnant contacts

3. Roseola Infantum (HHV-6)

Category: Viral Exanthem
Key Features:
  • High fever for 3-5 days
  • Rash appears as fever resolves
  • Rose-pink macular rash
  • Typically affects 6-24 months old
Diagnostic Points:
  • Clinical diagnosis
  • PCR for HHV-6 if needed
  • Characteristic fever pattern
  • Rash timing diagnostic

4. Varicella (Chickenpox)

Category: Viral Exanthem
Key Features:
  • Moderate fever
  • "Dew drops on rose petals" appearance
  • Pruritic vesicular rash in different stages
  • Centripetal distribution
Diagnostic Points:
  • Clinical diagnosis usually sufficient
  • Tzanck smear
  • PCR from vesicular fluid
  • VZV IgM/IgG

5. Hand, Foot, and Mouth Disease

Category: Viral Exanthem
Key Features:
  • Low-grade fever
  • Vesicular lesions on palms, soles
  • Oral ulcers
  • Usually caused by Coxsackievirus A16
Diagnostic Points:
  • Clinical diagnosis
  • PCR from vesicular fluid
  • Viral culture
  • Distribution pattern diagnostic

6. Erythema Infectiosum (Fifth Disease)

Category: Viral Exanthem
Key Features:
  • Low-grade or no fever
  • "Slapped cheek" appearance
  • Lacy reticular rash on extremities
  • Caused by Parvovirus B19
Diagnostic Points:
  • Clinical appearance often diagnostic
  • Parvovirus B19 IgM
  • PCR for Parvovirus B19
  • Important in pregnant contacts

7. Zika Virus Infection

Category: Viral Exanthem
Key Features:
  • Mild fever
  • Maculopapular rash
  • Conjunctivitis
  • Joint pain
Diagnostic Points:
  • RT-PCR in acute phase
  • Zika virus IgM
  • Travel history crucial
  • Consider in endemic areas

8. Dengue Fever

Category: Viral Exanthem
Key Features:
  • High fever
  • Biphasic fever pattern
  • Petechial rash in recovery phase
  • Severe muscle/joint pain
Diagnostic Points:
  • NS1 antigen test
  • Dengue IgM/IgG
  • Complete blood count
  • Monitor for warning signs

9. Chikungunya

Category: Viral Exanthem
Key Features:
  • High fever
  • Maculopapular rash
  • Severe arthralgia
  • Headache
Diagnostic Points:
  • RT-PCR in early phase
  • Chikungunya IgM
  • Travel history
  • Distinguished from dengue

10. Infectious Mononucleosis

Category: Viral Infection
Key Features:
  • Fever
  • Maculopapular rash (especially with ampicillin)
  • Lymphadenopathy
  • Pharyngitis
Diagnostic Points:
  • Monospot test
  • EBV-specific antibodies
  • Complete blood count
  • Liver function tests

11. Scarlet Fever

Category: Bacterial Infection
Key Features:
  • High fever
  • "Sandpaper" rash
  • Strawberry tongue
  • Pastia's lines in skin folds
  • Associated with Group A Streptococcus
Diagnostic Points:
  • Rapid strep test
  • Throat culture
  • ASO titers
  • Monitor for complications

12. Meningococcemia

Category: Bacterial Infection - Emergency
Key Features:
  • High fever with rapid onset
  • Petechial/purpuric rash
  • Rapid progression
  • Signs of meningitis
Diagnostic Points:
  • Blood culture
  • CSF analysis
  • PCR for N. meningitidis
  • Immediate antibiotic treatment

13. Toxic Shock Syndrome

Category: Bacterial Toxin-Mediated
Key Features:
  • High fever
  • Diffuse erythroderma
  • Hypotension
  • Multisystem involvement
Diagnostic Points:
  • Blood cultures
  • Complete metabolic panel
  • Coagulation studies
  • Source identification crucial

14. Staphylococcal Scalded Skin Syndrome

Category: Bacterial Toxin-Mediated
Key Features:
  • Fever
  • Tender erythema
  • Superficial desquamation
  • Nikolsky sign positive
Diagnostic Points:
  • Clinical diagnosis
  • Skin biopsy if unclear
  • Blood culture
  • Monitor fluid status

15. Rocky Mountain Spotted Fever

Category: Rickettsial Disease
Key Features:
  • High fever
  • Maculopapular → petechial rash
  • Wrists/ankles → central spread
  • Headache, myalgia
Diagnostic Points:
  • Serologic testing
  • PCR from skin biopsy
  • Tick exposure history
  • Early treatment crucial

16. Lyme Disease

Category: Bacterial Infection
Key Features:
  • Low-grade fever
  • Erythema migrans
  • Bulls-eye appearance
  • Multiple lesions in disseminated disease
Diagnostic Points:
  • Two-tier testing
  • ELISA followed by Western blot
  • Tick exposure history
  • Geographic consideration

17. Mycoplasma Infection

Category: Bacterial Infection
Key Features:
  • Fever
  • Stevens-Johnson-like rash
  • Pneumonia
  • Mucositis
Diagnostic Points:
  • PCR from throat swab
  • Serology (IgM, IgG)
  • Chest X-ray
  • Cold agglutinins

18. Rat-Bite Fever

Category: Bacterial Infection
Key Features:
  • Relapsing fever
  • Maculopapular/petechial rash
  • Arthralgia
  • Exposure history
Diagnostic Points:
  • Blood culture
  • Gram stain
  • Animal exposure history
  • Consider in pet rat owners

19. Typhoid Fever

Category: Bacterial Infection
Key Features:
  • Step-ladder fever pattern
  • Rose spots on abdomen
  • Relative bradycardia
  • Hepatosplenomegaly
Diagnostic Points:
  • Blood culture
  • Widal test
  • Stool culture
  • Travel history important

20. Cat Scratch Disease

Category: Bacterial Infection
Key Features:
  • Low-grade fever
  • Primary inoculation lesion
  • Regional lymphadenopathy
  • Cat exposure history
Diagnostic Points:
  • Bartonella henselae serology
  • PCR from lymph node
  • Lymph node biopsy
  • Cat exposure history

21. Ehrlichiosis

Category: Rickettsial Disease
Key Features:
  • High fever
  • Maculopapular rash
  • Severe myalgia
  • Tick exposure
Diagnostic Points:
  • PCR testing
  • Peripheral blood smear
  • Serologic testing
  • Monitor blood counts

22. Gonococcal Disease

Category: Bacterial Infection
Key Features:
  • Fever
  • Pustular skin lesions
  • Arthritis
  • Adolescent consideration
Diagnostic Points:
  • Culture from lesions
  • NAAT testing
  • Joint fluid analysis
  • Screen for other STIs

23. Secondary Syphilis

Category: Bacterial Infection
Key Features:
  • Low-grade fever
  • Copper-colored rash
  • Palms/soles involvement
  • Lymphadenopathy
Diagnostic Points:
  • RPR/VDRL
  • Treponemal tests
  • Dark field microscopy
  • CSF analysis if indicated

24. Relapsing Fever

Category: Bacterial Infection
Key Features:
  • Recurring fever episodes
  • Petechial rash
  • Jaundice
  • Tick/louse exposure
Diagnostic Points:
  • Blood smear during fever
  • PCR testing
  • Exposure history
  • Geographic consideration

25. Leptospirosis

Category: Bacterial Zoonosis
Key Features:
  • Biphasic fever
  • Conjunctival suffusion
  • Petechial rash
  • Exposure to contaminated water
Diagnostic Points:
  • MAT (gold standard)
  • ELISA IgM
  • PCR in early phase
  • Liver/kidney function tests

26. Kawasaki Disease

Category: Vasculitis
Key Features:
  • High fever ≥5 days
  • Polymorphous rash
  • Conjunctival injection
  • Oral changes
  • Cervical lymphadenopathy
  • Extremity changes
Diagnostic Points:
  • Clinical criteria based diagnosis
  • Elevated inflammatory markers
  • Echocardiogram mandatory
  • Monitor for coronary aneurysms

27. Systemic Juvenile Idiopathic Arthritis

Category: Autoimmune
Key Features:
  • High spiking fever
  • Salmon-pink evanescent rash
  • Arthritis
  • Lymphadenopathy
Diagnostic Points:
  • Ferritin levels
  • Complete blood count
  • Joint imaging
  • Exclude infections

28. Henoch-Schönlein Purpura

Category: Vasculitis
Key Features:
  • Low-grade fever
  • Palpable purpura
  • Abdominal pain
  • Arthralgia
Diagnostic Points:
  • Clinical diagnosis
  • Skin biopsy if unclear
  • Urinalysis monitoring
  • Renal function tests

29. Stevens-Johnson Syndrome

Category: Severe Drug Reaction
Key Features:
  • High fever
  • Severe mucocutaneous involvement
  • Target lesions
  • Often drug-triggered
Diagnostic Points:
  • Clinical presentation
  • Skin biopsy
  • Drug history crucial
  • Monitor fluid/electrolytes

30. DRESS Syndrome

Category: Severe Drug Reaction
Key Features:
  • High fever
  • Extensive rash
  • Eosinophilia
  • Internal organ involvement
Diagnostic Points:
  • RegiSCAR criteria
  • Complete blood count
  • Liver function tests
  • Drug history essential

31. Serum Sickness

Category: Immune Complex Disease
Key Features:
  • Fever
  • Urticarial rash
  • Joint pain
  • Following medication/antiserum
Diagnostic Points:
  • Clinical diagnosis
  • C3/C4 levels
  • Drug/antiserum history
  • Inflammatory markers

32. Acute Rheumatic Fever

Category: Post-Streptococcal
Key Features:
  • Fever
  • Erythema marginatum
  • Migratory arthritis
  • Carditis
Diagnostic Points:
  • Jones criteria
  • ASO titers
  • ECG/Echocardiogram
  • Prior strep history

33. Sweet Syndrome

Category: Neutrophilic Dermatosis
Key Features:
  • Fever
  • Tender erythematous plaques
  • Neutrophilia
  • Associated conditions
Diagnostic Points:
  • Skin biopsy
  • Complete blood count
  • Search for underlying cause
  • Inflammatory markers

34. PFAPA Syndrome

Category: Periodic Fever Syndrome
Key Features:
  • Periodic fever
  • Aphthous stomatitis
  • Pharyngitis
  • Cervical adenitis
Diagnostic Points:
  • Clinical diagnosis
  • Pattern recognition
  • Exclusion of other causes
  • Response to steroids

35. CAPS (Cryopyrin-Associated Periodic Syndromes)

Category: Autoinflammatory
Key Features:
  • Recurrent fever
  • Urticaria-like rash
  • Cold-triggered symptoms
  • Joint/CNS involvement
Diagnostic Points:
  • Genetic testing (NLRP3)
  • Family history
  • Clinical features
  • Response to IL-1 blockers

36. TRAPS (TNF Receptor Associated Periodic Syndrome)

Category: Autoinflammatory
Key Features:
  • Prolonged fever episodes
  • Migratory rash
  • Periorbital edema
  • Severe myalgia
Diagnostic Points:
  • TNFRSF1A gene testing
  • Inflammatory markers
  • Family history
  • Response to biologics

37. MIS-C (Multisystem Inflammatory Syndrome in Children)

Category: Post-Infectious Inflammatory
Key Features:
  • High fever
  • Polymorphic rash
  • Multi-organ dysfunction
  • Post-COVID association
Diagnostic Points:
  • CDC/WHO criteria
  • SARS-CoV-2 serology
  • Inflammatory markers
  • Cardiac evaluation

38. Primary Hemophagocytic Lymphohistiocytosis

Category: Immune Dysregulation
Key Features:
  • Persistent fever
  • Variable rash
  • Hepatosplenomegaly
  • Cytopenias
Diagnostic Points:
  • HLH-2004 criteria
  • Ferritin levels
  • Genetic testing
  • Bone marrow examination

40. Langerhans Cell Histiocytosis

Category: Histiocytic Disorder
Key Features:
  • Fever
  • Seborrheic-like rash
  • Bone lesions
  • Multi-system involvement
Diagnostic Points:
  • Skin/bone biopsy
  • CD1a/S100 staining
  • Skeletal survey
  • PET-CT if indicated

41. Acrodynia (Mercury Poisoning)

Category: Heavy Metal Toxicity
Key Features:
  • Low-grade fever
  • Pink, painful hands/feet
  • Photosensitivity
  • Hypertension
Diagnostic Points:
  • Blood/urine mercury levels
  • Environmental history
  • 24-hour urine collection
  • Neurological evaluation

42. Acrodermatitis Enteropathica

Category: Nutritional Deficiency
Key Features:
  • Fever
  • Periorificial dermatitis
  • Alopecia
  • Diarrhea
Diagnostic Points:
  • Zinc levels
  • Alkaline phosphatase
  • Skin biopsy
  • Response to zinc

43. Acute Generalized Exanthematous Pustulosis

Category: Drug Reaction
Key Features:
  • High fever
  • Sterile pustules
  • Rapid onset
  • Drug association
Diagnostic Points:
  • EuroSCAR criteria
  • Skin biopsy
  • Drug history
  • Differentiate from pustular psoriasis

44. Erythema Multiforme

Category: Immune-Mediated
Key Features:
  • Fever
  • Target lesions
  • Post-infectious/drug
  • Mucosal involvement
Diagnostic Points:
  • Clinical diagnosis
  • HSV PCR if indicated
  • Drug history
  • Skin biopsy if atypical

45. Familial Mediterranean Fever

Category: Autoinflammatory
Key Features:
  • Recurrent fever
  • Erysipelas-like erythema
  • Serositis
  • Ethnic predisposition
Diagnostic Points:
  • MEFV gene testing
  • Acute phase reactants
  • Family history
  • Colchicine response

46. Neonatal Lupus

Category: Autoimmune
Key Features:
  • Fever
  • Annular lesions
  • Heart block
  • Maternal antibodies
Diagnostic Points:
  • Anti-Ro/La antibodies
  • ECG/echocardiogram
  • Maternal history
  • Skin biopsy

47. Hyperimmunoglobulin D Syndrome

Category: Autoinflammatory
Key Features:
  • Recurrent fever
  • Cervical lymphadenopathy
  • Maculopapular rash
  • Early onset
Diagnostic Points:
  • MVK gene mutation
  • IgD levels
  • Mevalonic acid testing
  • Genetic counseling

48. CANDLE Syndrome

Category: Autoinflammatory
Key Features:
  • Recurrent fever
  • Violaceous eyelid edema
  • Lipodystrophy
  • Growth delay
Diagnostic Points:
  • PSMB8 gene testing
  • Interferon signature
  • Skin biopsy
  • Metabolic evaluation

49. Schnitzler Syndrome

Category: Autoinflammatory
Key Features:
  • Chronic fever
  • Urticarial rash
  • Bone pain
  • Monoclonal gammopathy
Diagnostic Points:
  • Strasbourg criteria
  • Serum protein electrophoresis
  • Bone scan
  • IL-1 blockade response

50. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

Category: Severe Drug Reaction
Key Features:
  • High fever
  • Extensive rash
  • Facial edema
  • Internal organ involvement
Diagnostic Points:
  • RegiSCAR criteria
  • Eosinophil count
  • Liver function tests
  • HHV-6 reactivation

51. Papular-Purpuric Gloves and Socks Syndrome

Category: Viral Infection
Key Features:
  • Fever
  • Edema and erythema of hands/feet
  • Petechial purpura
  • Parvovirus B19 association
Diagnostic Points:
  • Clinical diagnosis
  • Parvovirus B19 serology
  • Complete blood count
  • Self-limiting course

52. Rowell Syndrome

Category: Autoimmune
Key Features:
  • Fever
  • Lupus-like lesions
  • Erythema multiforme-like lesions
  • Chilblain-like lesions
Diagnostic Points:
  • ANA testing
  • Anti-Ro/La antibodies
  • Rheumatoid factor
  • Skin biopsy

53. Gianotti-Crosti Syndrome

Category: Post-Viral
Key Features:
  • Low-grade fever
  • Symmetric acral papules
  • Lymphadenopathy
  • Associated with various viruses
Diagnostic Points:
  • 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.



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