Differential Diagnosis for a 6-year-old child with persistent fever, strawberry tongue, and peeling skin on fingers
Single most likely diagnosis
- Kawasaki Disease: This condition is characterized by fever lasting for more than five days, accompanied by symptoms such as a strawberry tongue, peeling skin, and other specific criteria like bilateral conjunctival injection and cervical lymphadenopathy. The combination of persistent fever, strawberry tongue, and peeling skin in a child strongly points towards Kawasaki Disease.
Other Likely diagnoses
- Scarlet Fever: Caused by Group A beta-hemolytic streptococcal infection, it presents with fever, a strawberry tongue, and a rash that can desquamate. However, the rash typically starts on the trunk and spreads, and the desquamation is more generalized.
- Toxic Shock Syndrome: Although less common in children, it can present with fever, rash, and desquamation, along with other systemic symptoms like hypotension and involvement of multiple organ systems.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Staphylococcal Scalded Skin Syndrome (SSSS): Caused by staphylococcal toxins, it leads to widespread skin exfoliation and can be life-threatening. The initial presentation might resemble other conditions, but the rapid progression and severity of skin involvement are key distinguishing features.
- Streptococcal Toxic Shock Syndrome: Similar to Toxic Shock Syndrome but caused by streptococcal infection. It's a medical emergency with high mortality if not promptly recognized and treated.
Rare diagnoses
- Erythema Multiforme: A skin condition characterized by target lesions and can involve mucous membranes. While it can have a variety of triggers, including infections and medications, the presentation with fever, strawberry tongue, and peeling skin would be atypical.
- Autoimmune disorders (e.g., Juvenile Idiopathic Arthritis, Systemic Lupus Erythematosus): These conditions can present with fever and rash but are less likely to cause the specific combination of strawberry tongue and peeling skin on fingers as primary symptoms.