Fever and Rash
Fever and Rash
The rash of rubeola (measles) starts at the hairline 2–3 days into the illness
and moves down the body, typically sparing the palms and soles. Koplik’s spots
(1 to 2 mm white or bluish lesions with an erythematous halo on the buccal
mucosa)are pathognomonic for measles and are generally seen during the first 2
days of symptoms.
CENTRALLY DISTRIBUTED MACULOPAPULAR
ERUPTIONS
Rubella (German measles) also spreads from the hairline downward; unlike
that of measles, however, the rash of rubella tends to clear from originally
affected areas as it migrates, and it may be pruritic. Forchheimer spots (palatal
petechiae) may develop but are nonspecific because they also develop in
infectious mononucleosis, scarlet fever, and Zika virus infection. Postauricular
and suboccipital adenopathy and arthritis are common among adults with
rubella.
The rash of erythema infectiosum (fifth disease), which is caused by human
parvovirus B19, primarily affects children 3–12 years old; it develops after fever
has resolved as a bright blanchable erythema on the cheeks (“slapped
cheeks”)with perioral pallor. A more diffuse rash (often pruritic) appears the next
day on the trunk and extremities and then rapidly develops into a lacy reticular
eruption that may wax and wane (especially with temperature change) over 3
weeks. Adults with fifth disease often have arthritis, and fetal hydrops can
develop in association with this condition in pregnant women.
CENTRALLY DISTRIBUTED MACULOPAPULAR
ERUPTIONS
• Rickettsial illnesses
Rocky Mountain spotted fever: Early diagnosis and therapy are critical
because of its grave prognosis if untreated. Lesions evolve from macular to
petechial, start on the wrists and ankles, spread centripetally, and appear on
the palms and soles only later in the disease.
Secondary syphilis: which may be generalized but is prominent on the palms
and soles, should be considered in the differential diagnosis of pityriasis rosea,
especially in sexually active patients.
Chikungunya fever: transmitted through aedes mosquito,associated with a
maculopapular eruption and severe polyarticular small-joint arthralgias.
PERIPHERAL ERUPTIONS
Hand-foot-and-mouth disease, most commonly caused by coxsackievirus A16
or enterovirus 71, is distinguished by tender vesicles distributed on the hands
and feet and in the mouth; coxsackievirus A6 causes an atypical syndrome with
more extensive lesions.
The classic target lesions of erythema multiforme appear symmetrically on
the elbows, knees, palms, soles, and face. In severe cases, these lesions spread
diffusely and involve mucosal surfaces, associated with Herpes simplex virus,
mycoplasma and drugs like Chloroquine.
Bacterial Endocarditis also present with peripheral lesions like Janeway lesions
and Osler’s node.
CONFLUENT DESQUAMATIVE ERYTHEMAS