Differential Diagnosis for a 4-year-old with Viral Infection
Single most likely diagnosis
- Hand, Foot, and Mouth Disease (HFMD): This is a common viral illness in children, characterized by a rash on the face, hands, and feet, along with fever, vomiting, and sometimes drooping of the face due to facial weakness. The symptoms match closely with those described, and the duration of about 5 days is typical for HFMD.
Other Likely diagnoses
- Herpangina: Another viral infection that causes mouth sores and can lead to vomiting and fever. While it doesn't typically cause a rash on the face, some variants might, and the overall clinical picture could fit, especially if the "rash" is interpreted as mouth sores.
- Viral Gastroenteritis: This condition, often referred to as the stomach flu, can cause vomiting, upset stomach, and sometimes fever. If the child has a viral gastroenteritis with a concurrent or preceding viral infection causing facial rash, this could be considered.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Botulism: Although rare, botulism can cause facial weakness (leading to a "droopy" face), vomiting, and can be associated with gastrointestinal symptoms. It's crucial to consider this diagnosis due to its severity and the need for prompt treatment.
- Meningitis: While the symptoms don't directly point towards meningitis, any infection that causes severe headache, fever, vomiting, and could potentially lead to facial weakness (in the case of cranial nerve involvement) should prompt consideration of this diagnosis due to its high morbidity and mortality if untreated.
Rare diagnoses
- Kawasaki Disease: This is a rare condition that mainly affects children under the age of 5. It can cause fever, rash, swelling of the hands and feet, and sometimes gastrointestinal symptoms. Facial weakness is not a typical symptom, but the rash and other symptoms could fit, making it a rare but possible diagnosis.
- Guillain-Barré Syndrome: A rare autoimmune disorder that can occur after a viral infection, leading to muscle weakness, which could be interpreted as a "droopy" face in a child. It's a diagnosis that would be considered if the child's symptoms progress to include significant weakness or paralysis.