Image IQ: Infant with skin peeling

January 30, 2020

A 20-month-old boy with skin peeling, a strawberry red tongue and swelling of the hands and feet. Can you diagnose this patient?

Parents of a 20-month-old boy brought him to his pediatrician after his fever lasted for longer than a week. At first, they thought he had a bad diaper rash, but then realized that the erythema on his perineum was actually skin peeling. They grew more concerned when they noticed their son’s hands and feet were swelling and he had a strawberry red tongue.

Can you diagnose the patient? Use thedifferential builder in VisualDxas a guide.

A. Erythema multiforme
B. Rubeola
C. Scarlet fever
D. Kawasaki disease

See the next page for the correct diagnosis.

The correct diagnosis is D) Kawasaki disease

Synopsis:  Kawasaki disease (KD), or mucocutaneous lymph node syndrome, is a self-limited, multisystem vasculitis that affects infants and children. The disease occurs primarily in children under the age of 6. It is classically characterized by fever lasting at least 5 days (usually longer) plus 4 of the 5 following criteria:

Conjunctival injection without exudate 

  • Red lesions of the mouth or pharynx

  • Acute hand and foot edema followed by peeling

  • Polymorphous cutaneous eruption

  • Lymphadenopathy (usually cervical)

KD often presents with significant perineal erythema and subsequent desquamation over 2 days before development of diagnostic features of the disease. Careful evaluation and close follow-up is necessary for identification of other subtle clinical features suggestive of KD.

The most significant and potentially life-threatening complications are cardiovascular. Pericarditis, myocarditis, coronary arteritis, and endocarditis leading to arrhythmias can occur as early as 7 days from the onset of fever.

To learn more about this condition, visit VisualDx.