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Rash with Fever in Adult (Petechial, Purpuric (Rocky Mountain Spotted…
Rash with Fever in Adult
Maculopapular Rash
Centrally Distributed
Vector Borne
Lyme Disease
:silhouette: Macule or papule at site of tick bite, progresses to pathognomonic erythema migrans (warm, apruritic, painless, bull's eye apperance)
Borrelia burgdoferi
:check: fever, headache, fatigue, rash, lymphadenopathy; advanced infection - facial droop, neck stiffness, palpitations, dizziness, SOB
:mag: EIA followed by serology
Ehrlichiosis
Ehrlichia chaffeensis
and
Ehrlichia ewingii
:check: Fever, Headache, Chills, Malaise, Muscle Pain, N/V/D, Confusion, Conjunctivitis, Rash (60% paeds, 30% adults)
:silhouette: apruritic, spectrum from maculopapular to petechial, may cause erythroderma which peels
:mag: Diagnosis by serological testing; thyombocytopenia, leukpenia
:warning: may infect individuals via blood transfusion as infects white cells
Drug Related Eruptions
DRESS
:check: New medication, malaise, lymphadenopathy, symptoms, high grade fever
:silhouette: lymphadenopathy, facial edema, ilfiltrative lesions, scaling
GVHD
:check: N/V/D, anorexia, HX of BMT, use of immunosuppression medication
:silhouette: rash on neck, ear, shoulders, palms, sole
Viral
Rubella
:red_flag: Mostly in children but possible in young adults
:check: fever, rash, lymphadenopathy, coryza, headache, myalgia, red eyes (prodrome 1-5 days before rash)
:silhouette: macular rash, from face to neck, trunk then extremities. Macules may coalesce at trunk; inflammation of fingers
:mag: serology for rubella-specific Ab
Dengue Fever
:check: sudden high fever, severe headache, retro-orbital pain, chills, myalgia, arthalgia , N/V, bleeding. Rash is 2-5 days after fever
:silhouette: MP or macular confluent rash over face, thorax and flexor, with islands of skin sparing; lymphadenopathy, tachy/bradycardia, conduction defects, facial flushing
:mag: Leukopenia, molecular culture, serology. + haematocrit, hypoproteinemia, + PT, + aPPT, - fibrinogen, + fibrin split products;
positive torniquet test
Infectious Mononucleiosis
:check: fever, arthralgia and myalgia, nausea, anorexia, cough, ocular muscle pain, chest pain, photophobia.
classic triad: fever, pharyngitis, lymphadenopathy
; rash 5-9d after antibiotics
:silhouette: lymphatdenopathy, periorbital edema; late hepatosplenomegaly,
palatal petechiae
, jaundice, uvular edema; (non)exudative pharyngitis, tonsilar enlargement
Demomyostitis
:check: acute onset fever, weight loss, myostitis
:silhouette: raynaud's phenomenon,mechanic's hands, nonerosive arthritis
TSS
:check:fever, myalgia, pharyngitis, vomiting, SSTI
:silhouette: diffuse erythema, hypotension, palsm and soles, encephalopathy
Peripherally Distributed
Erythema Multiforme
Mucous Membrane Involvement
SJS/TEN
:silhouette:Dull-red macules developing into papules with central vesicles or bullae; common on dorsa of hands, palms, soles, arms, knees, penis and vulva; often bilateral and symmetric
:check: non-specific URTI, 1-14 days prodrome, abrupt mucocutaneous lesions.
:red_flag: Fever may suggest overlapping infection
Minor Disease
:warning: absence of bullae/systemic symptoms
:check: precedes HSV outbreak
:silhouette: Extensor surface distribution
Secondary Syphilis
:silhouette: preferential rash in head, neck, palm, soles; diffuse. Brown-red/pink macule/papule.
:warning: eruption is two to six months after primary infection
:check: acute constitutional symptoms, macules in oral and genital mucosa
Petechial, Purpuric
Rocky Mountain Spotted Fever
Ricketssia ricketsii
, tick borne disease
:check: Apr -Sept, abrupt development of rash (4th day)
after
fever, rigor, photophobia, prostration, nausea
:silhouette: pink macules, 2-6 mm, wrists, forearms, ankles, palms, soles. 6-18h rash moves centrally to arms, thighs, trunk, face, Then develops to deep-red papules.
round shape
Meningococcemia
:check: epidemic or midwinter. Short prodrome, then rash and spiking fever
:silhouette: classic petechial rash, tachypnea, tachcardia, mild hypotension, Signs of meningeal irritation
Acute Bacterial Endocarditis
:check: high grade fever, weight loss, pain (pleuritic), anorexia, dyspnea, shaking chills
:silhouette: petechiae, extremities, splinter hemorrhages, janeway lesions, osler nodes, roth spots, cardiac murmurs
Dengue develops to petichiae rash
Polyarteritis Nodosa
:check: fever, weakness, weight loss, arthalgia; middle-aged adults
:silhouette: can present with multiple lesions with different morphology
Vesicular
Shingles/Zoster
:check: fever (20%), then rash. Intense pain by slight touch; old age
:silhouette: erythematous maculopapular lesions that is unilateral and dermatomal. papule to vesicles to pustules/hemorrhage lesions
Staph. bacteremia
:silhouette: impetigo, purulent cellulitis, abscess
:check: fever, hypotension; prosthetic device
HSV infection
if immunocompromised
Rickettsialpox
:red_flag: caused by
Rickettsia akari
house mite
:silhouette: local eschar, papulaovesicular rash
:check: mild clinical course
Vibrio vulnificus
:check: underlying liver, renal or diabetes. V/D, abdo pain, chills, fever
From seafood or water handling
:silhouette: bullous skin lesion at trunk and LL; rapid onset of cellulitis to necrotising fasciitis
Nodular Eruptions
Erythema Nodosum
:check: F>M, fever malaise, arthalgia
:silhouette: painful, tender nodules, legs, knees, arms.
Multiple aetiologies
Fungal infection in immunocompromised
Disemminated Candidiasis (in IC patient)
Pustular
:check:widespread
AGEP
:check: acute development of non-follicular pustules. few hours to few days after drug administration
Face or intertriginous to trunk and limbs; diffuse or patchy
Facial oedema. Fever > 38 in acute phase
generalised pustular psoriasis
:check: acute picture with abrupt development of widespread, painful erythematous patches. Make coalesce. Crop emerges with fever
:silhouette: jaundice, lower limb edema, ocular abnormalities, mucosal involvement
:red_cross: widespread
Gonococcemia
:check: polyarthragia,tenosynovitis, chills, multiple sex partners and unprotected sex
:silhouette: petechiae to papule, pustule, vesicle. Dorsal surface of distal extremities, near joints
Plaques
Cellulitis
:check: fever, malaise, rigors, painful spreading rash
:silhouette: diffused edge, unilateral, inflammation, lower extremities, interdigital toe fissures
Erysipelas
:check: acute fever, chills, rigors, tender spreading rash
:silhouette: red raised border, inflammation, unilater, interdigital toe fissures
Sweet Syndrome
:check: abrupt rash, fever, malaise, inflammatory disease, URTI
:silhouette: erythematous plaques.nodules
Erythema migrans
:check: painless expanding border; fever in 16%,
tick borne
:silhouette: bull's eye appearance at axilla/inguinal/popliteal fossa/belt line
Necrotising Fasciitis
:check: super painful and tender rash, anaesthesia, fever, malaise, D/N
:silhouette:red -> black colour, skin breakdown, bullous, gangrene, tachycardia