Differential Diagnoses

Varicella Low grade fever, anorexia, and headache Rash progresses from papules to pustulues, with significant pruritus Begins on trunk and spreads to extremities Emerge in various asynchronous crops Rash lasts days

Rubella Low grade fever and anorexia Maculopapular rash appears on face and neck and spreads to the rest of the body Spares the palms and soles Fades after 3 dasy

Erythema Infectiosum Fifth Diseases Commonly affects ages 5-15 years old, but can occur at any age Prodrome lasts 2-5 days: low grade fever, headache, and malaise May also include arthralgia, arthritis, pharyngitis, conjunctivitis, cough, and diarhea “slapped cheek” sign  generalized maculopapular rash on neck, body, and extremities Resolving rash appears in a lacy reticular pattern

Hand-Foot-and-Mouth Disease Low-grade fever, malaise, anorexia, and posterior pharyngeal ulcerations Oral lesions on whole palate and tongue, spares gingival mucosa Maculopapular lesions appear on hands and feet that progresses to vesicles and then ulcerations

Roseola Several days of high, unremitting fever followed by defervescence, then abrupt onset of diffuse macular or maculopapular rash Condition improves with appearance of rash

Scarlet Fever Pharyngitis with associated rash Rash appears as erythematous papules that start around the neck and then spreads to the trunk, more prominent at skin creases Erythematous cheeks, circumoral region is spared Strawberry tongue Desquamation on rash affected areas

Meningococcemia Nonspecific febrile prodrome Associated lethargy, poor appetite, headache, and neck stiffness Petechiae or purpura may or may not appear Hypotensive, tachycardic Fever  rash

Rocky Mountain Spotted Fever Fever 2-5 days Prodrome: headache, myalgia, fever, nausea, vomiting, diarrhea, abdominal pain, and jaundice Rash appears on 2 nd to 4 th day and begins on thenar eminence and flexor surfaces of wrists and ankles, palms and soles usually affected History of tick bite Fever  rash

Hemolytic Uremic Syndrome Prodrome: fever, nausea, vomiting, diarrhea, abdominal pain Rash appears 5-10 days after diarrheal illness Irritability, pallor, and hepatosplenomegaly

Kawasaki Disease Fever and blanching rash Children under 5 years old Irritability and anterior uveitis Criteria – Bilateral conjunctival injection – Oropharyngeal changes (red or fissured lips, injected pharynx, strawberry tongue) – Peripheral extremity changes (acute erythema, edema, desquamation) – Non vesicular morbilliform rash, primarily truncal – Cervical lymphadenopathy

Henoch-Schonlein Purpura Affects ages 2-11 years old Upper respiratory tract prodrome Arthritis, nephritis, edema, or abdominal pain Nonblanching rash that evolve into palpable nonthrombocytomenic purpura Appears on buttocks and lower extremities