Differential Diagnosis for a Child with Fever and a Rash
Disease Description Typical features from H&P
Systemic-onset
juvenile idiopathic
arthritis (JIA)
One of a group of
common rheumatic
diseases subdivided into:
Oligoarthritis (or
pauciarticular
disease),
Polyarthritis, or
Systemic-onset
disease (also called
Still's disease)
Prolonged fever could suggest Still's
disease
Rash
Arthritis (although active arthritis in Still's
disease often presents months to years
after onset)
Visceral involvement
(e.g., hepatosplenomegaly,
lymphadenitis, serositis)
8/15
Kawasaki disease Vasculitis
Fever > 5 days
Nonpurulent conjunctivitis (may have
cleared prior to presentation)
Rash
Swelling and erythema of extremities
Osteomyelitis/septic
joint
Bacterial infection (80%
of cases occur in the
lower extremities)
Low-grade fever
Painful walking (if in lower extremity)
Rocky Mountain
spotted fever
(RMSF)
Tick-borne bacterial
infection (Rickettsia
rickettsii)
Fever
Headache
Rash (typically starts on ankles and
wrists and progresses centrally and to
palms and soles*; may be maculopapular
at first, quickly becoming petechial; in 5%
of cases, there may be no rash)
Myalgias
*Other causes of rash involving palms and
soles: Kawasaki disease, enteroviruses,
syphilis.
Scarlet fever Group A Streptococcus
infection
Fever (generally < 5 days)
A diffuse, erythematous, finely papular
rash (described as having a "sandpaper"
texture) is pathognomonic
Rash often begins at neck, axillae, and
groin and then spreads over trunk and
extremities, typically resolving within four
or five days
Stevens-Johnson
syndrome
A mucocutaneous
disorder caused by a
hypersensitivity reaction
to medications,
infections, or other
illnesses
Severe, pruritic rash (erythema
multiforme)
Fever (not expected to last 7 days)
Mucosal changes (e.g., stomatitis)
Conjunctivitis
9/15
Viral syndrome
(enterovirus)
Covers wide variety of
viral infections
Fever lasting 3-5 days (but not a
prolonged high fever)
Non-descript rash (enteroviruses can
cause rash on palms and soles)
Rash is not painful and should not cause
refusal to walk