Differential diagnosis

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Since the diagnosis of KD is essentially clinical, some conditions should be taken into consideration in the differential diagnosis. These include scarlet fever, staphylococcal toxic shock syndrome, poly-morph erythema, viral infections, systemic-onset juvenile idiopathic arthritis, and polyarteritis no-dosa. The main differential clinical features of these conditions can be summarized as follows:

Scarlet fever: throat swab positive for group A beta hemolytic Streptococcus, good response to antibiotic treatment.

Staphylococcal toxic shock syndrome: more frequent in the second infancy, compromized general conditions, shock, early coagulation abnormalities.

Polymorph erythema: no conjunctivitis, polycy-clic lesions of the oral mucosa, typical skin marginated lesions.

Viral infections (Adenovirus, Rubeola, Parvovi-rus, Epstein-Barr virus, Cytomegalovirus): good general conditions, epidemic presentation, positive serology.

Systemic-onset juvenile idiopathic arthritis: intermittent fever, arthritis more prevalent, morning stiffness.

Polyarteritis nodosa: painful skin nodules, internal organ involvement, specific pathology.

Children may present with only fever and a unilateral enlarged cervical lymph node. The rash and mucosal changes that follow often are mistaken for a reaction to antibiotics that are administered for presumed bacterial lymphadenitis. Sterile pyuria may be mistaken for a partially treated urinary tract infection with sterile urine cultures. The young infant may present with fever, rash, and cerebrospinal fluid pleocytosis and be misdiagno-zed with viral meningitis. Occasionally, a child may present with an acute abdomen and be admitted to a surgical service (Zulian et al., 2003). KD should be considered in the differential diagnosis of every child with fever of at least several days' duration, rash, and non-purulent conjunctivitis, especially in children < 1-year old and in adolescents, in whom the diagnosis is frequently missed.

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