Is This Scarlet? Bacterial versus Viral Exanthem in Limited Resource Setting

We report a case of a generalized bacterial-induced skin desquamation mimicking viral exanthem in a 10-year-old boy, providing insight for primary physicians on identifying tricky diagnostic cues in a type C general hospital with no attending dermatologist.
The patient presented with a chief complaint of high fever with generalized desquamation. Initial skin lesion was generalized erythematous skin rash, which evolved into vesicles and pustules, followed by a generalized desquamation. An initial diagnosis of bacterial infection was established. The patient was discharged after 8 days, with no fever but ongoing skin desquamation accompanied by mild sting and itch. Ten days after discharge, previously uninvolved areas of palms, soles, and intergluteal cleft started to exfoliate. Limited by the unavailability of specific supporting examinations, we eliminated differential diagnoses by relying on careful history taking and clinical symptoms, and pinpointed a more precise diagnosis of scarlet fever.