Hand Foot Mouth Differential Diagnosis
The differential diagnosis for hand foot mouth disease can be organized into the following categories:
Single Most Likely Diagnosis
- Hand Foot Mouth Disease (HFMD) caused by Coxsackievirus A or Enterovirus 71: This is the most common cause of the characteristic rash and oral ulcers in children, often accompanied by fever and malaise.
Other Likely Diagnoses
- Herpangina: Also caused by Coxsackieviruses, it presents with similar oral ulcers but typically without the hand and foot rash.
- Herpes Simplex Virus (HSV) infection: Can cause oral ulcers and, in some cases, rash on the hands and feet, especially in immunocompromised individuals.
- Varicella (Chickenpox): Although it typically presents with a more widespread rash, it can sometimes be confused with HFMD, especially in the early stages.
Do Not Miss Diagnoses
- Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN): These are severe skin and mucous membrane disorders, usually a reaction to medication or infection, which can present with skin lesions and oral ulcers. Early recognition is crucial due to their high morbidity and mortality.
- Kawasaki Disease: An acute febrile illness of childhood that can present with rash, oral changes, and extremity changes, which requires prompt diagnosis and treatment to prevent cardiac complications.
- Erythema Multiforme: An immune-mediated condition that can present with target lesions and oral ulcers, often triggered by infections or medications.
Rare Diagnoses
- Enterovirus 71 with severe neurological complications: While HFMD caused by Enterovirus 71 is not rare, the development of severe neurological complications such as encephalitis or acute flaccid paralysis is less common but critical to recognize.
- Measles: In areas where measles is not common due to vaccination, it might be a rare consideration but can present with a rash and oral changes (Koplik spots).
- Rickettsial infections: Such as Rocky Mountain Spotted Fever, which can present with rash and fever, although oral ulcers are less common.