EM · Paediatric rashes and febrile illness

Paediatric rashes and febrile illness

Also known as Febrile rash · Paediatric exanthem · Meningococcal rash · Kawasaki disease · Henoch-Schonlein purpura · IgA vasculitis

The febrile child with a rash is a high-stakes presentation because a small number of rashes signal time-critical disease while the majority are benign viral exanthems. The Fellowship candidate must read rash morphology first: a non-blanching petechial or purpuric rash with fever is meningococcal septicaemia until proven otherwise and earns ceftriaxone 50 mg per kilogram intravenously immediately, while a fever of five days or more with bilateral non-purulent conjunctivitis, a polymorphous rash, a strawberry tongue and swollen hands is Kawasaki disease, treated with intravenous immunoglobulin 2 g per kilogram and aspirin within ten days of fever onset to prevent coronary artery aneurysm. Measles descends from the hairline after a prodrome of fever, coryza, cough and conjunctivitis with Koplik spots; chickenpox is a vesicular rash in crops at different stages; erythema multiforme is a target rash with at most one mucosal site; and Henoch-Schonlein purpura is a palpable purpura on the lower limbs with abdominal pain, arthritis and renal involvement. The differential is the viral exanthem, the drug reaction and the autoimmune vasculitis, distinguished by morphology, tempo, distribution and toxicity. ACEM-primary, globally tagged.