Emergency Department Management of Rash and Fever in the Pediatric Patient (Infectious Disease CME and Pharmacology CME) -

Emergency Department Management of Rash and Fever in the Pediatric Patient (Infectious Disease CME and Pharmacology CME)
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Publication Date: January 2020 (Volume 17, Number 01)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 01/01/2023.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME and 0.5 Pharmacology CME credits, subject to your state and institutional approval.


Rhonda L. Philopena, MD

Assistant Professor of Emergency Medicine and Pediatric Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY
Erin M. Hanley, MD
Assistant Professor of Pediatrics and Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY
Kayla Dueland-Kuhn, MD
SUNY Upstate Medical University, Syracuse, NY

Peer Reviewers

Jeffrey R. Avner, MD, FAAP
Chairman, Department of Pediatrics, Professor of Clinical Pediatrics, Maimonides Children’s Hospital of Brooklyn, Brooklyn, NY
Nicole Gerber, MD
Assistant Professor of Clinical Pediatrics, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY


Rash and fever are some of the most common chief complaints presenting to the emergency department. The evaluation of rashes in the febrile pediatric patient includes a broad differential diagnosis and use of the history and physical examination to identify red flags, such as hemodynamic instability, erythroderma, desquamation, petechiae/purpura, mucous membrane involvement, and severe pain, that should increase suspicion for worrisome disease. This issue reviews characteristics of common rashes as well as rarer, potentially life-threatening rashes, to guide management and treatment and improve patient outcomes.

Excerpt From This Issue

You arrive to a busy afternoon shift in the ED. Your first patient is a 1-year-old boy with rhinorrhea, congestion, cough, and 3 days of fever up to 39.4°C (103°F), measured rectally. His parents state that he has been playful at home and continues to eat and drink normally. They have been giving him acetaminophen and ibuprofen sporadically, but today he developed a generalized rash, and they became concerned. His vital signs are as follows: temperature, 38.7°C (101.7°F); heart rate, 135 beats/min; and blood pressure, 85/55 mm Hg. On examination, the rash is macular, erythematous, and blanching, but his eyes and mouth appear normal.

In the next room, there is a 3-year-old boy with a similar history who had mild rhinorrhea and a low-grade fever of 38.1°C (100.5°F) at home. His parents are concerned that he has been complaining of pain in his legs, on which they have noticed dark spots. He has continued to drink well, though he has been eating slightly less. His vitals signs are as follows: temperature, 37.5°C (99.5°F); heart rate, 120 beats/min; and blood pressure, 90/60 mm Hg. You observe some nonblanching spots on his lower extremities and buttocks, as well as mild edema and tenderness of his knees and ankle, but the boy is still able to bear weight with a mild limp.

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