Which diagnosis best fits a patient with conjunctivitis, strawberry tongue, and desquamation of the skin?

Which diagnosis best fits a patient with conjunctivitis, strawberry tongue, and desquamation of the skin?

• A. Kawasaki disease
• B. Scarlet fever
• C. Measles
• D. Toxic shock syndrome

Answer: (A)

Conjunctival injection with mucous membrane changes and subsequent skin desquamation in a child is classic for Kawasaki disease, a pediatric vasculitis. The combination of persistent fever plus non-purulent conjunctivitis, strawberry tongue (red, bumpy tongue due to inflamed taster papillae), and desquamation of the skin reflects widespread mucocutaneous inflammation seen in this condition. This pattern is much more characteristic of Kawasaki disease than the other options. Scarlet fever can show strawberry tongue and fever, but it typically presents with a sandpapery rash and pharyngitis, not the prominent conjunctival involvement. Measles features fever, cough/coryza, conjunctivitis, Koplik spots, and a characteristic morbilliform rash, with desquamation not being an early defining feature. Toxic shock syndrome involves rapid, severe illness with hypotension and multisystem failure; while conjunctival injection and later desquamation can occur, the classic presentation centers on shock and systemic involvement, not the mucocutaneous triad described here. Timely recognition of Kawasaki disease is crucial to prevent coronary artery aneurysms, with treatment usually consisting of IVIG and aspirin.

Conjunctival injection with mucous membrane changes and subsequent skin desquamation in a child is classic for Kawasaki disease, a pediatric vasculitis. The combination of persistent fever plus non-purulent conjunctivitis, strawberry tongue (red, bumpy tongue due to inflamed taster papillae), and desquamation of the skin reflects widespread mucocutaneous inflammation seen in this condition. This pattern is much more characteristic of Kawasaki disease than the other options.

Scarlet fever can show strawberry tongue and fever, but it typically presents with a sandpapery rash and pharyngitis, not the prominent conjunctival involvement. Measles features fever, cough/coryza, conjunctivitis, Koplik spots, and a characteristic morbilliform rash, with desquamation not being an early defining feature. Toxic shock syndrome involves rapid, severe illness with hypotension and multisystem failure; while conjunctival injection and later desquamation can occur, the classic presentation centers on shock and systemic involvement, not the mucocutaneous triad described here.

Timely recognition of Kawasaki disease is crucial to prevent coronary artery aneurysms, with treatment usually consisting of IVIG and aspirin.