Differential Diagnosis for Painful White Plaques over Tongue, Fever, and Refusal to Eat in a 1-Year-Old Child

• Single Most Likely Diagnosis
  • Oral Thrush (Candidiasis): This is the most likely diagnosis given the age of the child and the symptoms of painful white plaques over the tongue, fever, and refusal to eat. Oral thrush is a common fungal infection in infants and young children, especially after antibiotic use or with poor oral hygiene.
• Other Likely Diagnoses
  • Herpetic Gingivostomatitis: Caused by the herpes simplex virus, this condition can present with painful oral ulcers, fever, and refusal to eat. It's common in young children and can be accompanied by similar symptoms.
  • Hand, Foot, and Mouth Disease: Although it typically presents with vesicles on the hands and feet, the oral lesions can sometimes appear as white plaques or ulcers, accompanied by fever.
• Do Not Miss Diagnoses
  • Bacterial Pharyngitis or Tonsillitis: While less likely to cause white plaques, severe bacterial infections can lead to significant morbidity if not treated promptly. The presence of fever and refusal to eat warrants consideration of these conditions.
  • Diphtheria: A rare but potentially life-threatening condition that can cause a membrane to form over the tonsils and throat, leading to respiratory obstruction. Although rare in areas with high vaccination coverage, it's crucial not to miss this diagnosis.
• Rare Diagnoses
  • Autoimmune Disorders (e.g., Pemphigus or Pemphigoid): These conditions are rare in children and can cause blistering lesions in the mouth, but they are much less common than infectious causes.
  • Leukemia: Although extremely rare, leukemia can cause oral ulcers and plaques, along with systemic symptoms like fever. It's essential to consider this in the differential diagnosis due to its severity, even though it's unlikely.