Some red rashes in children.

(Current Pediatrics 20th) Condition Incubation Prodrome Period (d) Adenovirus 45 URI; cough; fever Morbilliform (may Normal; may see be petechial) leukopenia or lymphocytosis Upper or lower respiratory symptoms are prominent. No Koplik spots. No desquamation. Drug allergy None, or fever alone, or with myalgia, pruritus Enterovirus 27 Variable fever, chills, throat Usually macular, maculopapular on soles; vesicles or Variable; PCR Macular, maculopapular, urticarial, or erythroderma Leukopenia, eosinophilia Rash variable. Severe reactions may resemble measles, scarlet fever; Kawasaki disease; marked toxicity possible. Varied rashes may resemble those of many other infections. Pharyngeal or hand-footRash Laboratory Tests Comments, Other Diagnostic Features

myalgia, sore trunk or palms,

petechiae also seen Ehrlichiosis (monocytic) 521 Fever; headache; flulike; myalgia; GI symptoms Variable; maculopapular, petechial, scarlatiniform, vasculitic Leukopenia, abnormal liver function. Serology for diagnosis; morulae in monocytes Erythema multiforme Usually none Discrete, red or related to maculopapular underlying cause lesions; symmetrical, distal, palms and soles; target lesions classic Infectious 3060 Fever, Macular, Atypical Normal or eosinophilia

mouth vesicles may occur.

Geographic distribution is exposure; rash present in only 45%.

thrombocytopenia, a clue; seasonal; tick

Reaction to drugs (especially sulfonamides), or infectious agents (Mycoplasma; herpes simplex virus). Urticaria, arthralgia also seen.

Pharyngitis,

mononucleosis (EBV infection)

malaise

scarlatiniform, or urticarial in 5% to are on penicillins and related drugs (not a penicillin allergy)

lymphocytosis; heterophil specific antibodies in an acute pattern EBV; abnormal liver function tests Increases inflammatory leukocytosis; thrombocytosis

lymphadenopathy, hepatosplenomegaly.

almost 100% who antibodies; EBV-

Juvenile rheumatoid arthritis (systemic; Still diseases)

High fever, malaise

Evanescent salmon-pink in pressure areas (prominent when fever is present)

Oligo- or polyarticular arthritis; asymptomatic anterior uveitis.

macules, especially markers;

Kawasaki disease

Unknown

Fever, cervical irritability

Polymorphous (may be trunk and

Leukocytosis, thrombocytosis, reactive protein;

Swollen hands, feet; prolonged illness; uveitis; response to antibiotics.

adenopathy, erythroderma) on

elevated ESR or C- aseptic meningitis; no

extremities; red palms and soles, conjunctiva, lips, tongue, pharynx.

pyuria; decreased albumin; negative cultures and streptococcal

Vasculitis and aneurysms of coronary and other arteries occur (cardiac ultrasound).

Late desquamation serology; resting is common. Some tachycardia of these findings may be absent with atypical disease Leptospirosis 419 Fever (biphasic), myalgia, chills Measles 914 Cough, rhinitis, Maculopapular; Variable erythroderma Leukocytosis; hematuria, proteinuria; Conjunctivitis; hepatitis, aseptic meningitis may be seen. Rodent, dog

hyperbilirubinemia contact. Leukopenia; antiToxic. Bright red rash becomes confluent, may desquamate. Fever falls

face to trunk; lasts measles IgM

conjunctivitis 710 d; Koplik

spots in mouth

after rash appears. Inadequate measles vaccination.

Parvovirus (erythema infectiosum)

1017 (rash)

Mild (flulike) Maculopapular on IgM-EIA; PCR cheeks ("slapped cheek"), forehead, chin; then down limbs, trunk, buttocks; may fade and reappear for several weeks

Purpuric stocking-glove rash is rare, but distinctive; aplastic crisis in patients with chronic hemolytic anemia. May cause arthritis or arthralgia.

Rocky Mountain spotted fever

312

Headache (retroorbital); toxic; GI symptoms; high fever;

Onset 26 d after fever; palpable palms, soles, extremities, with spread centrally;

Leukopenia;

Eastern seaboard and States; AprilSeptember; tick exposure.

thrombocytopenia; southeastern United function; CSF pleocytosis; serology positive at

maculopapular on abnormal liver

flulike

petechial

710 d of rash; biopsy will give earlier diagnosis

Roseola (exanthem subitum) (HHV-6)

1014

Fever (34 d) Pink, macular rash Normal occurs at the end of febrile period; transient

Fever often high; disappears when rash develops; child appears well. Usually occurs in children 6 mo3 y of age. Seizures may complicate.

Rubella

1421

Usually none Mild maculopapular; rapid spread face to extremities; gone by day 4

Normal or leukopenia

Postauricular, occipital adenopathy common. Polyarthralgia in some older girls. Mild clinical illness. Inadequate rubella vaccination.

Staphylococcal Variable scalded skin

Irritability, absent to

Painful erythroderma,

Normal if only colonized by

Normal pharynx. Look for focal staphylococcal

low fever

followed in 12 d by cracking around eyes, mouth; bullae form with friction (Nikolsky sign)

staphylococci; leukocytosis and sometimes bacteremia if infected

infection. Usually occurs in infants.

Staphylococcal 17 scarlet fever

Variable fever

Diffuse erythroderma; resembles streptococcal scarlet fever except eyes may be hyperemic, no "strawberry" tongue, pharynx

Leukocytosis is common because of infected focus

Focal infection usually present.

spared StevensJohnson syndrome Pharyngitis, fever, malaise Bullous erythema slough in large areas; hemorrhagic lips; purulent conjunctivitis Leukocytosis Classic precipitants are drugs (especially sulfonamides);

conjunctivitis, multiforme; may

Mycoplasma pneumoniae
and herpes simplex infections. Pneumonitis and urethritis also seen.

Streptococcal scarlet fever

17

Fever, abdominal pain, headache, sore throat

Diffuse erythema, "sandpaper" texture; neck, axillae, inguinal areas; spreads to rest of body; d; eyes not red

Leukocytosis; positive group A

Strawberry tongue, red pharynx with or without exudate. Eyes, perioral palms, and soles spared. Pastia lines. Cervical adenopathy. Usually occurs in children 210 y of age.

Streptococcus
wound; positive streptococcal pharynx

culture of throat or and periorbital area,

desquamates 714 antigen test in

Toxic shock syndrome

Variable

Fever, myalgia, headache, diarrhea, vomiting

Nontender

Leukocytosis;

Staphylococcus aureus
infection; toxin-mediated multiorgan involvement. Swollen hands, feet. Hypotension or shock.

erythroderma; red abnormal liver eyes, palms, soles, enzymes and pharynx, lips coagulation tests; proteinuria

CSF, cerebrospinal fluid; EIA, enzyme immunoassay; ESR, erythrocyte sedimentation rate; GI, gastrointestinal; HHV-6, human herpesvirus 6; IFA, immunofluorescent assay; PCR, polymerase chain reaction; URI, upper respiratory infection.