Differential Diagnosis
The patient's symptoms, including a high fever, generalized maculopapular rash, bilateral nonsuppurative conjunctivitis, erythematous cracked lips, swollen bumpy tongue, and swelling of the hands and feet, suggest an infectious or inflammatory condition. The following differential diagnoses are considered:
Single most likely diagnosis
- Kawasaki disease: This condition is characterized by fever, rash, conjunctivitis, changes in the lips and oral cavity, and swelling of the hands and feet, which are all present in this patient. The presence of bilateral, nonexudative conjunctivitis and the specific pattern of symptoms point towards Kawasaki disease.
Other Likely diagnoses
- Scarlet fever: Although the rash and fever could suggest scarlet fever, the absence of a sore throat and the presence of conjunctivitis make it less likely.
- Viral exanthem (such as measles or roseola): These conditions can present with fever and rash but typically have other distinguishing features such as cough, coryza, or a distinct pattern of rash.
- Adenoviral infection: This could explain some symptoms like conjunctivitis and fever, but the full spectrum of symptoms doesn't perfectly align with a typical adenoviral infection.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Toxic shock syndrome: Although less likely given the specific constellation of symptoms, toxic shock syndrome is a life-threatening condition that requires prompt recognition and treatment. The presence of fever, rash, and potential for multi-organ involvement necessitates consideration of this diagnosis.
- Bacterial sepsis: Any child with a high fever and systemic symptoms should be evaluated for bacterial sepsis, especially if there's a suspicion of a bacterial infection that could lead to severe consequences if not promptly treated.
Rare diagnoses
- Juvenile idiopathic arthritis (JIA) with systemic features: While JIA can present with fever and rash, the specific pattern and accompanying symptoms in this case make it less likely.
- Leptospirosis or other zoonotic infections: These could present with a wide range of symptoms including fever and rash, but are less common and would typically be associated with specific exposures.
- Autoimmune lymphoproliferative syndrome (ALPS): A rare condition that could present with lymphadenopathy and systemic symptoms, but is much less common and would require specific diagnostic testing for confirmation.
Given the options provided for the remainder of the physical examination, B) Bilateral, multiple, shotty anterior cervical lymph nodes is the most likely finding in Kawasaki disease, which is the single most likely diagnosis based on the symptoms described.