The combination of a rash and fever in a child can be a cause of great concern for parents and physicians alike. A wide range of conditions can lead to this pair of symptoms. They can be differentiated by which symptom appears first, the duration of each symptom and the type of rash.
Viral Infections
The most common viral infection to cause rash and fever in a child is varicella zoster, or chicken pox. The itchy rash often is described as fluid-filled "dewdrops on a rose petal." It is accompanied by fever, general malaise, headache and body aches. Less common viral illnesses, such as measles and rubella, also can cause a rash and fever in a child. Many children are now immunized against these. Fifth disease, caused by human parvovirus b19, gives the appearance that the child's cheeks have been slapped. Roseola, caused by human herpesvirus-6, spares the face and is distinctive in that a fever precedes the rash.
Bacterial Infections
Bacteria can cause a rash and fever, such as in scarlet fever or impetigo, both caused by streptococcal bacteria. Bacterial also is behind staphylococcal scalded skin syndrome, in which high fever is accompanied by blistering and peeling of the skin. These three conditions are mostly seen in very young children. In older children and adolescents, Lyme disease and Rocky Mountain spotted fever can cause rash and fever accompanied by joint pain and other symptoms following a tick bite. The most frightening type of rash in an adolescent is that caused by Neisseria meningitidis, the bacteria responsible for most cases of meningitis in adolescents. A child or adolescent with rash, fever and neck stiffness should be isolated immediately, taken to the emergency room and treated for meningitis.
Kawasaki's Disease
An uncommon condition, Kawasaki's disease is caused by inflammation of the blood vessels in young children. A high fever that is unresponsive to acetaminophen is accompanied by a "strawberry tongue," non-blistering truncal rash, peeling skin and swollen lymph nodes. The causative agent is unknown and thought to be autoimmune in nature.
Immune-mediated Disorders
Other autoimmune conditions such as systemic lupus erythematosus can cause a butterfly-shaped rash across the cheeks and bridge of the nose or localized rash on a specific part of the body. Immune reactions to drugs, such as erythema multiforme or Steven-Johnsons syndrome, also can cause a rash that may be accompanied by high fever. If your child presents with a rash and fever, have him examined by a physician as early as possible to rule out dangerous conditions and treat him appropriately before any complications set in.
References
- Nelson Textbook of Pediatrics; Dr. Robert M. Kliegman, et al.; 2008
- PubMed Health: Kawasaki Disease
- AAFP: Evaluating the Febrile Patient with a Rash
