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Differential Diagnosis & Pitfalls

• Multisystem inflammatory syndrome in children (MIS-C)
• Patients with toxic shock syndrome most often have focal cutaneous skin infections, abscesses, infections associated with nasal packing, or a history of recent surgical procedures.
• COVID-19
• Erythema multiforme presents with symmetrically distributed target lesions. Patients frequently have coexisting herpes orolabialis.
• Reactive infectious mucocutaneous eruption (RIME) – Characterized by prominent mucositis and a sparse eruption that may be polymorphous in association with underlying Mycoplasma pneumoniae or other infection.
• Viral exanthems like measles may be difficult to distinguish from KD. However, patients with measles often display an exudative conjunctivitis and Koplik spots within the oral mucosa.
• The cutaneous and mucosal findings in scarlet fever may also easily be confused with KD. However, these patients respond to anti-streptococcal antibiotic therapy.
• Staphylococcal scalded skin syndrome presents with erythema and desquamation accentuated within skin folds.
• Distinguishing drug reactions (eg, Stevens-Johnson syndrome) from KD can be difficult. A careful drug history is critical.
• KD can present with red cheeks, as does fifth disease (erythema infectiosum). Premature closure on fifth disease leading to missing KD is a diagnostic pitfall.
• For oral findings, also consider hand-foot-and-mouth disease, stomatitis (contact, aphthous), and candidiasis.

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