Exanthema in the Differential Diagnosis of Childhood Infectious Diseases. Dress Syndrome in a Teenager (Clinical Case)

Exanthema is one of the most prominent visual clinical signs of both infectious and non-infectious diseases in childhood. Among skin manifestations in paediatric infectious diseases, several types of exanthems can be observed, including roseolous, macular, papular, vesicular, bullous, pustular, petechial, haemorrhagic-necrotic, erythema nodosum and others. In a significant number of cases, exanthema is accompanied by mucosal lesions — enanthema. For instance, in chickenpox, enteroviral infections and herpes simplex virus type I infection, vesicles form on the mucous membranes, which quickly transform into aphthae. In measles, enanthema is usually localised opposite the molars and presents as small red spots with central whitish deposits (Koplik’s spots).However, the exanthema syndrome is also found in many non-infectious conditions, which poses certain diagnostic challenges, especially in paediatric practice.Particular attention should be paid to conditions in which skin rashes are accompanied by fever, systemic toxicity and changes in internal organs.A review of the literature was conducted regarding the main dermatological manifestations of infectious diseases in children that are accompanied by exanthema. A classification of infectious exanthems was carried out according to the morphological characteristics of the rash elements, and their association with other clinical signs of infectious diseases in children was analysed.A clinical case is presented involving the difficult diagnosis of DRESS syndrome in an adolescent with a mononucleosis-like presentation and exanthema, which was initially misinterpreted as a manifestation of an infectious disease. Understanding the features of rash onset and distribution, its correlation with other clinical symptoms, careful collection of medical and life history, as well as comprehensive laboratory and instrumental investigations followed by in-depth analysis of the results are key factors for timely diagnosis and, consequently, appropriate treatment.