Atypical viral rashes can be a diagnostic challenge in immunocompromised children, especially those with oncohematologic conditions or solid tumors. These rashes often resemble drug reactions, infections, or graft-versus-host disease, each requiring different treatments. Given the vulnerability of these patients—whose immune systems are weakened by their disease or treatment—an accurate diagnosis is essential for appropriate care. In cases of infections, timely identification is also crucial for public health and infection control.
We present four cases of atypical rashes in pediatric patients with cancer, linked to community-acquired respiratory viruses such as rhinovirus and respiratory syncytial virus (RSV). Molecular diagnostics confirmed the viral origins. The rashes were temporary, non-itchy or mildly itchy, and mostly affected the trunk and limbs. In all cases, the rashes resolved on their own without the need for altering the current treatment plan or performing invasive procedures.
These findings emphasize the role of respiratory viruses, like rhinovirus and RSV, in causing skin reactions. They also highlight the value of noninvasive molecular testing to prevent misdiagnosis and unnecessary treatments. Such viral rashes are rarely reported in the medical literature, and our case series adds to the understanding of skin manifestations linked to these viruses. It also reinforces the importance of a multidisciplinary approach when assessing rashes in pediatric cancer patients.
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