Adult, Fever and Rash

Macules/Papules

Erythema

Vesicles/Bullae

Nodules
(immunocompromised)

Petechia/purpura

Urticaria

Infection

Bacterial

Rocky Mountain spotted fever by Rickettsia rickettssi via tick 🚩 (Stanford's Big Four)

  • Bite --with in one week-> fever + HEADACHE -> Rash after fever (may be intially maculopapular -> petechial)
  • Spring/Summer

Acute Endocarditis (2nd to Staph. A)

  • Heart disease/ IV drug use/ New or changing murmur

Virus

Epstein-Barr virus (EBV)

  • mononucleosis type syndrome: pharyngitis, fever, malaise, adneopathy splenomegaly, and hepatitis
  • Heterophile antibodies

Dengue

Life-threatening infection : 🚩 Lassa fever virus, Ebola virus, Marburg virus, and Machupo virus

Non-infectious

Thrombotic thrombocytopenia purpura (TTP)

  • Classic pentad: fever, hemolytic anemia, thrombocytopenia, neurologic dysfunction, and decreased renal function

Systemic vasculitis syndromes

  • Dxg: Vasculitis on skin biopsy

Drug induced vasculitis with fever:

  • variety such as alloprinol, phenytoin, penicillin, sulfonamides, and thiazides

Leukocytoclastic vasculitis

Sepsis 🚩

Infection

Staphylococcal Toxic Shock Syndrome (STSS)

  • Syndrome: fever, diffuse erthematous rash, hypotension, mutlisystem dysnfuction, hyperemic mucous membrane, desquamation on palms and soles

Scarlet fever

  • Cause: Streptococcal pyrogenic exotoxin
  • Follow pharyngitis or other Strep infections
  • Signs: Erythroderma in skin folds, circumoral pallor, strawberry tongue

Streptococcal Toxic Shock Syndrome

  • GAS or steptococcs pyogenes
  • S&S: bacteremic, strep infection with skin (bullae often develop at the site)

Infection

Non-Infection

Viral

Drug (7-10 days into therapy)

Measles (rubeola) ⚠

  • fever, coryza, and mp rash (start in h&n spread centrally) Koplik's spots

Rubella

  • fever, malaise, pst cervical lymphadenopathy + petechiae on soft palate

5th disease (erthema infectiosum - Parvovirus B19)

  • slapped-cheek appearance, recur with sun exposure, adult also present with arthritis and arthralgias
  • Papular-purpuric gloves and socks syndrome (painful, puritic swelling of distal extremities) - adult

Cytomegalovirus (CMV)

  • mononucleosis-type illness

Acute Human Immunodeficiency Virus Seroconversion

  • fever, pharyngitis, lymphadenopathy and rash, malaise, myalgias, arthalgias (1-6 week after infection)

EBV (refer to petechia/purpura section

Human Herpesvirus-6 (HHV6) -> roseola or exanthem subitum

  • mn-like illness + rsh after fever resolve / acute hepatitis

Enteroviruses mostly present with mp rash but some can present as petechial or vesicular rash / pharyngitis or diarrhea

  • common cause of aseptc meningitis

Bacterial

Asenteroviruses

Neisseria meingitidis infection 🚩 (Stanford's Big Four)

  • Rapid progression and systemic toxicity.
  • GDxg: blood culture
  • Empirical antibioticif suspected meningococcemia (CSF)
  • Purpura fulminans

Syphilis via Treponema pallidum (2nd stage) - palms and sole rashes

RMSF can present as mp rash in early stage

Ehrlichiosis

Human monoytotropic ehrlichiosis (HME) via Ehrlichia chaffeensis

Human granulocytotropic anaplasmosis (HGA) via Anaplasma phagocytophilum (rash is rare)

Lyme disease via Borrela burgdorferi

Dengue can present as macular

Typhoid fever via Salmonella typhi

Infectious Vesicles

Viral

Varicella-Zoster Virus

  • Complications: pneumonia, encephalitis, Reye's syndrome
  • Different stages

HSV1&2

Bacterial

Vibrio vulnificus (bullous skin)

Meningococcemia 🚩

Systemic Diseases

Acute graft-versus-host disease

Kawasaki diseases

Rheumatological disease

Anaphylactic reactions 🚩

Toxic epidermal necrolysis >30% BA/
Stevens-Johnson syndrome <10% BA 🚩 (Stanford's Big Four)

  • can cause by infections or cancer (rare)
  • Allopurinol, antibiotics, antipsychotics, antiepileptics, and NSAID

Drug reaction with eosinophilia and systemic symptoms (DRESS)

Staphylococcal scalded skin syndrome (SSSS)

Toxic Shock Syndrome (TSS) via Staph A. or GAS 🚩 (Stanford's Big Four)

Malignancy

Variola (same stage)

Pseudomonas

Infectious Bullae

Necrotic Fasciitis and GAS gangrene

Scabies (bullous variant)

Vibrio

  • Consumption of raw seafood

Autoimmune

Bullous pemphigoid

Pemphigus vulgaris

Drug reaction e.g TEN

Contact Dermatitis

Eschar (bioterrorism mostly)

Bacterial

Francisella tularensis

  • handling of infected vectors

Anthrax (Bacillus anthracis)

Yersinia pestis -> plague

Hematological malignancies

Transplant patients

Bacterial

Fungal

HIV

Atypical mycobacteria

Erythema nodosum (tender eryt nod confine to lower extremities)

Yersinia, Chlamydia, fungi, M. Tb

Sweet's syndrome (febrile neutrophilic dermatosis

Serum-sickness secondary to Hep B

Parasitic infection

Acute schisotosomiasis

Strongyloidiasis

Fliaral infection

Trichinosis

Necrotizing Fasciitis Streptococcus pyogenes

Cellulitis via Staph A. and B-Hemolytic Strep

Staphylococcal scalded skin syndrome

Non-Infectious

drug eruptions (DRESS syndrome)

Kawasaki disease

Recalcitrant erythematous desquamating disorder

  • Staph producing toxin especially in AIDs

Infectious mononucleosis

  • associated with aminopenicillin admin (within 3 days)