Differential Diagnosis of Exanthematous Diseases in Children: Clinical and Prognostic Significance

Fever with rash is a common presentation in childhood and has a very wide differential diagnosis, ranging from benign viral exanthems to life-threatening conditions such as meningococcaemia, toxic shock syndrome, Kawasaki disease and multisystem inflammatory syndrome. The aim of this review is to systematise the clinical approach to the differential diagnosis of exanthematous diseases in children and to show how the diagnosis determines prognosis and management. Based on international guidelines and peer-reviewed publications, the article describes the diagnostic value of rash morphology, timing, distribution, enanthem, lymphadenopathy and laboratory tests; compares the typical clinical features and complications of measles, rubella, scarlet fever, varicella, erythema infectiosum, roseola infantum, enteroviral infection, meningococcal disease, Kawasaki disease and MIS-C; and proposes a prognostic framework based on red-flag signs.