The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

Lindsey R. Baden, M.D., Editor

Rubella Rash
A B

Satoshi Kutsuna, M.D., Ph.D.
Kayoko Hayakawa, M.D., Ph.D.
National Center for Global Health
and Medicine
Tokyo, Shinjuku-ku, Japan
sonare.since1192@gmail.com
A
23-year-old woman presented to the emergency department
after 1 day of fever, sore throat, arthralgia, and rash. Diffuse erythema
(Panel A) that blanched on pressure was noted over the face, neck, trunk,
and arms, along with posterior cervical lymphadenopathy. The next day, the fever
and rash subsided, but she reported pain in the oral cavity. Examination revealed
petechial hemorrhages on the soft palate (Panel B) that disappeared spontaneously
in 2 days. She had no history of rubella vaccination. Testing for rubella IgG anti-
body was negative, and testing for rubella IgM antibody was positive, which con-
firmed the clinical diagnosis of rubella. The number of rubella cases in Japan, es-
pecially in Tokyo, has been increasing in the past year. Approximately 70% of
reported cases of rubella involve middle-aged men, partly because boys were not
vaccinated against rubella by the national immunization program until 1995. To
prevent the congenital rubella syndrome, the vaccination of women of childbearing
age and their partners is currently a priority.
DOI: 10.1056/NEJMicm1303608
Copyright © 2013 Massachusetts Medical Society.

558 n engl j med 369;6 nejm.org august 8, 2013

The New England Journal of Medicine

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