Differential Diagnosis For Rash and Feverdr. Irma Suswati, M.Kes

How do you describe this rash?Multiple erythematous macules and/or papules, a few millimeters to 1 cm in sizecoalescing together. Symmetric distribution on trunk, extremities, and Intertriginous area.

Derm LingoMacule: flat, nonpalpable circumscribed area of change in the skin color, may be any size.Papule: small solid elevation of skin generally < 5 mm in diameter.Plaque: palpable, plateau-like elevation of skin > 5mm in diameter.Nodule: palpable, solid, round, or ellipsoidal lesion > 5 mm diameter. Vesicle (blister): circumscribed, elevated lesion that is < 5 mm in diameter containing serous (clear) fluid.Bulla: A vesicle with a diameter > 5 mm.Pustule: superficial, elevated lesion that contains pus.Cyst: an epithelial lined cavity containing liquid or semisolid material.Wheal: transitory, compressible papule or plaque of dermal edema

How do you describe this rash?Multiple tense vesicles and bullae around the axilla.

Describing a RashColorMarginationShapePalpationNumberArrangementConfluenceDistribution

The Presence of Fever & Rash should raise the following questions?Site of onset, rate & direction of spread.Distribution, configuration and arrangement of the lesion?Is there erythema, hypo, or hyperpigmentation?Are there secondary characteristics such as scale?Is pruritus present?Is the patient taking any meds (prescription, OTC, herbal)Travel History?Immune Status?

Differential Dx for maculopapular Rash and FeverViral Exanthems: rubeola, rubella, erythema infectiosum (Parvo), roseola (HHV-6), Coxssackievirus, echovirus, EBV, adenovirus, dengue, CMV,Bacterial Infections: Strep pyogenes (Scarlet Fever), Staph aureus (TSS), MeningococcemiaOther Infections: Sec SyphilisDrug Eruption: (penicillin, tetracyclines, sulfonamides, dilantin, barbituates, phenylbutazone, NSAIDS, salicylates)Erythema MultiformeRheum: SLE, Reiters Syndrome

MEASLES - RASHCDC - B.RiceMurray et al. Medical Microbiology

MEASLES - Kopliks spotsMurray et al. Medical Microbiology

RUBELLAMurray et al. Medical Microbiology

A "slapped-cheek" appearance is typical of the rash for erythema infectiosum.(From Medical Microbiology, 5th ed., Murray, Rosenthal & Pfaller, Mosby Inc., 2005, Fig. 56-5.)Parvovirus pathogenesis

SLAPPED-CHEEK SYNDROME

Coxsackievirus, EchovirusExanthemsMorbilliform rashesFine, erythematous, maculopapular rashesCommon in summer monthsRash appears simultaneously with fever and starts on faceAssociated with echovirus 9

Coxsackievirus, EchovirusRoseoliform rashesDiscrete, nonpruritic, salmon-pink macules and papules on the face and upper chestProdrome of fever and pharyngitisRash appears after defervescence and lasts 1-5 daysContagious especially amongst young childrenEchovirus 16 most commonly associated

Coxsackievirus, EchovirusGeneralized vesicular eruptionsMost frequently caused by coxsackievirus A9 and echovirus 11Lesions look like those of hand-foot-and-mouth but occur in crops on the head, trunk and extremitiesDo not evolve into pustules or scabs (unlike chickenpox)

Coxsackievirus, EchovirusHerpanginaVesicular rash involving pharynx and soft palateSummer outbreaks of group A coxsackievirusFever, vomiting, myalgia and headache associated with prodrome

Coxsackievirus, EchovirusHand-foot-and-mouth diseaseDistinctive vesicular eruption usually caused by coxsackie A16 or enterovirus 71Most common in children under age 10Fever and vesicles in the mouth and on the hands and feetCan look like chickenpox but illness is generally milder

Scarlet fever

Staphylococcus scalded skin syndromeToxic shock syndrome

Differential Diagnosis for Bullous RashViral (HSV, Coxsackie, Varicella & Herpes Zoster)Bacterial (Staphylococcal) Bullous ImpetigoDrug RxnAllergic Contact DermatitisInsect BitePorphyria Cutanea TardaAutoimmune blistering diseases of the skin:Intraepidermal bullous diseases: Pemphigus vulgaris, Pemphigus foliaceus, Paraneoplastic pemphigusSubepidermal bullous diseases: Bullous Pemphigoid, Herpes Gestationis, Cicatricial Pemphigoid, Epidermolysis Bullosa Acquisita, Linear IgA Bullous Dermatosis

VZVClinical PresentationsPrimary infection = varicella (chickenpox) 14 day incubation periodCharacterized by generalized fever and vesicular lesionsUsually self-limiting in normal childrenMore severe in adults and immunocompromised personsMechanism of latency not as well understood as for HSV

VZVClinical PresentationsReactivation in adults = zoster (shingles)Painful unilateral vesicular rashDermatomally distributed (T3-T12; L1-L2; V1)Vesicles usually resolve in 2-3 weeks scarring possibleMost common complication: post-herpetic neuralgiaMore severe, often disseminated in immunocompromised persons encephalitis

HerpesHerpes Simplex