Fever with rash

Regarding the discussion on: 'fever and rash', let's share the knowledge. =)

a) Blanchable rash - due to vasodilation

b) Non blanchable rash - due to extravasation of bleed

DDx for fever and rash :

1) Dengue
2) Chicken Pox
3) Systemic JIA
4) Rubella
5) Measles
6) Meningococcemia rash
7) Scarlet fever
8) Kawasaki Disease
9) ITP
10) Leukemia ·

Palpable :

Papule - <0.5cm
Nodule - >0.5cm
Plaque - flat-topped, >1cm
Wheal - area of dermal edema (any
size), pale and compressible

Macule - flat, non palpale; in the

plane of skin; <1cm
Patch - Macule >1cm

Image : Macuolopapular rash -

raised and discolored cicumscribed
lesion

Vesicle - fluid filled blister; <0.5cm

Bulla - fluid filled blister >0.5cm

Pustule - collection of pus <1cm

Abscess - localized collection of pus in
a cavity >1cm

Chicken Pox (Primary varicella

zoster infection)

1) Fever - at time of rash

2) Rash
- comes in crops of papules,
vesicles at different times for up to
7 days.
- small erythematous macules →
papules → vesicles → crusting
- vesicular stage of rash : itchiest
- rash is usually absent on palms
and soles

** any new lesions after 10 days

suggest defective cellular immunity

Rubella (German Measles)

1) Rash
- generalized maculopapular rash
- discrete pale pink
- starts on face and neck → trunk and extremities
- usually fades on third day : NO
staining/desquamation
- not itchy in children

2) Lymphadenopathy - suboccipital, postauricular

3) Fever - absent or low grade.

Treatment - symptomatic treatment

Prevention - immunization

Scarlet Fever :

Prodromal symptoms for about 2 days before onset of

rash.

1) Characteristic of rash
- starting from neck and generalizes rapidly : more
prominent on neck, axillae, groin, skinfolds
- absent or sparse on face, palms and soles
- dry and rough texture → skin feels like fine sandpaper
- blanches on pressure
- *** Rash lasts about 5 days, and followed by fine
desquamation of rash.

2) Facial finding : flushing with circumoral pallor

3) Tongue :
~ Day 1-2 : classic appearance of white strawberry
tongue (heavily coated with white membrane,
protruding edematous red papillae)
~ Day 4-5 : red strawberry tongue (membrane sloughs
off, shiny red tongue with prominent papillae)
Measles :

1) Fever
- typically the first sign → high grade
- classical triad of 3C's : conjunctivits,
coryza and cough

2) Rash
- typically: 2-4 days after onset of fever
and lasts 3-5 days
- Koplik spots : D2 fever; white spots
on buccal mucosa; pathognomic but
difficult to see
- Rash D3 of fever;
immunocompromised patients may not
develop rash
- Pattern of rash : Ears → whole body
- Characteristic : maculopapular rash →
blotchy and confluent, may desquamate
in 2nd week.

Complications of measles
a) respiratory : pneumonia,
b) neurological : enxephalitis, subacute
sclerosing panencephalitis (SSPE)
c) otitis media
d) etc

Kawasaki disease :

1) Fever - >5 days.

2) Criteria :
- Conjunctival infection
- mucus membrane changes -
pharyngeal injection; red, dry and
cracked lips, strawberry tongue
- cervical lymphadenopathy
- rash - polymorphous
- extremities - red and edematous
palms, soles; after resolution there
is peeling of fingers and toes

Complications :
Cardiac **
a) pericardial effusion
b) myocardial disease
c) endocardial disease
d) coronary disease with aneurysm
formation ***
Meningococcal Rash :

- starts anywhere on the body and

then spread
- may or may not be present with
meningococcal meningitis
- characteristics :
a) non blanchable
b) irregular size and outline
c) necrotic center

Systemic JIA
Persistent joint swelling of >6 weeks
duration with absence of infection or
any other defined course; onset before
16 years old.

Rash pattern
- salmon colored, macular and non
itchy
- distribution : over trunk and
extremities, transient lesions.