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48 year old male with acute onset of fever, accompanying rash for 2 days…

- - - - Rubella, roseola, enteroviruses, erythema infectiosum
    - - Maculopapular rash
        
        Rash usually over trunk but can involve extremities => EBV-associated infectious mononucleosis. Usu. associated with aminopenicillin
        
        Small, erythematous to violaceous, purpuric or vesicular => Miliary TB. Other Sx: fever, night sweats, anorexia, weight loss, respi complaints
        
        Blanching erythematous "brick red" rash, begins in head & neck area, spreads centrifugally to trunk and extremities => Measles. Other Sx: cough, coryza, conjunctivitis, Koplik spots
      - Macular
        
        Rash becomes lacy and reticulated, spreads from limb to trunk and buttocks => Erythema infectiosum. Other Sx: lymphadenopathy, arthritis/athralgia, nausea, diarrhea
        
        Early lesions macular with rapid increase of petechial/purpuric lesions on distal extremities and trunk (spare palms and soles), may have urticarial rash => Meningococcal infection. Other Sx: myalgia, somnolence, headache, and nausea
        
        Rash in about 50% of cases, may be maculopapular/pruritic and occur over face, thorax, abdomen, extremities => Dengue. Rash usu. 2-5 days after fever onset. Other Sx: GI symptoms, RT symptoms (cough, sore throat, nasal congestion). PE: lymphadenopathy, hepatomegaly, facial puffiness
      - Petechiae
        
        Present on the skin, usually on the extremities or on mucous membranes e.g. palate/conjunctivae => bacterial endocarditis. Other Sx: splinter hemorrhages, Osler nodes, Janeway lesions, Roth spots
      - Desquamating
        
        Diffuse and erythematous rash, resembles sunburn => Toxic shock syndrome (TSS). Other Sx: hypotension, temp.>38.9, fever, diarrhea, muscle aches
      - Others
        
        Cellulitis: "Orange peel texture", warm swollen patch of skin. May present with vesicles, bullae, ecchymoses, petechiae.
        
        Palpable purpura => bacterial sepsis
        
        Superficial pustules with more disease in skin folds => acute generalised exanthematous pustulosis (AGES). Other Sx: malaise but not particularly unwell
  - - - Presence of target skin lesions, involvement of palms, sores and mucosal surfaces. WBC/liver enzymes elevated but not in SSLE. Other Sx: urticaria, edema, arthralgia, lympadenopathy
    - - Generalized maculopapular, mucous membranes involved
        
        Stevens-Johnson Syndrome (SJS), associated with Mycoplasma pneumoniae. Can also present with vesicular rash.
        
        Toxic epidermal necrolysis (TEN). Most associated with sulfonamides, antibiotic drugs. Other Sx (similar to SJS): mucositis, skin tenderness, malaise, myalgia
      - Urticarial
        
        Mostly urticarial, also pruritic => urticarial starts in the anterior lower trunk, groin, periumbilical, axillary regions, spreads to back, upper trunk, extremities => Serum sickness. Other Sx: arthralgia, myalgia
    - - Involves more than 50% of body surface area and/or includes at least 2 of: facial edema, infiltrated lesions, scaling, purpura. Initially involve face and upper trunk/extremities . Other Sx: malaise, lympadenopathy, no arthralgia