Fever and erythema in the emergency room

The emergency department presents difficult cases for the consulting dermatologist. One of the most challenging is the patient who presents with fever and an erythematous rash. The differential diagnosis of the erythrodermic patient in the emergency room can include drug eruptions (DRESS syndrome), Staphylococcal scalded skin syndrome, toxic shock syndrome, Kawasaki disease and Kawasaki disease-like Syndrome, and recalcitrant erythematous desquamating disorder. Evaluating these patients can be frustrating and requires patience and thoroughness to arrive at the correct diagnosis.