Hand-foot-and-mouth disease differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differential Diagnosis

• Herpes simplex virus infection
  • Herpangina
  • Herpes stomatitis
    • Associated with high grade fever, acute gingivitis and oral ulcerations.
    • The vesicles are small, grouped together and on an erythematous base.
    • Absence of rash on palms and soles.
    • A Tzank test shows multinucleated giant cells and direct fluorescent antigens test can also help to differentiate hand-foot-and-mouth disease from herpes simplex virus infection.
• Bacteremia and Sepsis
• Chicken pox
• Measles
• Pharyngitis
• Aphthous ulcers/ Gingivitis
  • The ulcers are on the mucosal surface of the mouth and is not associated with fever, malaise or rash.
• Stevens-Johnson syndrome/ Erythema multiforme
• Dehydration
• Henoch-Schönlein purpura
• Kawasaki disease
• Other rare conditions in children:
  • Behcet's disease
  • Pemphigus vulgaris