The combination of fever and rash is common in the pediatric population. Systemic etiologies, including meningococcal disease, rickettsial infections, viral infections such as measles and rubella, and drug hypersensitivity reactions are discussed in Chapter 4, Systemic Diseases Causing Fever and Rash. This chapter will discuss several additional etiologies specific to pediatric patients, including nonspecific viral exanthems, roseola infantum, erythema infectiosum, varicella-zoster infection, staphylococcal scalded skin syndrome, and Kawasaki disease.
A careful description of the timing of fever and appearance of skin lesions may be sufficient to narrow the diagnosis. Key elements of the history and physical are listed in Table 44.1.
The large majority of cases of pediatric fever and rash, more than 70% in one study, are caused by viruses, and only approximately 20% are caused by bacteria. Viral exanthems are usually reactive and may be caused by enteroviruses, adenoviruses, echovirus, and numerous others. Infections with enteroviruses often peak in summer and autumn months.
Nonspecific Viral Exanthems
A variety of enteroviruses may cause a symptom complex including fever, malaise, gastrointestinal complaints, meningitis, and rash (Table 44.2). The enterovirus exanthem is typically maculopapular, although petechiae mimicking meningococcal infection may be seen. Petechiae have also been reported with coxsackievirus A9, echovirus 9, coxsackievirus A4, B2–5, and echovirus 3, 4, and 7 infections.