A 3-year-old boy presents with a 2-day history of high fever, strawberry tongue, diffuse scarlatiniform rash, and bilateral non-purulent conjunctival injection. The hands and feet show edema and erythema. What is the most likely diagnosis?

• A Scarlet fever
• B Kawasaki disease ✓
• C Staphylococcal scalded skin syndrome
• D Toxic shock syndrome

Explanation

Kawasaki disease is diagnosed by fever for 5 or more days plus four of five principal features: bilateral non-purulent conjunctival injection, oral mucosal changes (strawberry tongue, fissured lips), cervical lymphadenopathy, polymorphous rash, and extremity changes (edema, erythema, desquamation). Scarlet fever has a sandpaper rash and responds to penicillin. Staphylococcal scalded skin syndrome shows Nikolsky sign and flaccid bullae.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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