Chapter e7

Given the extremely broad differential diagnosis, the presentation of a patient with fever and rash often poses a thorny diagnostic challenge for even the most astute and experienced clinician. Rapid narrowing of the differential by prompt recognition of a rash's key features can result in appropriate and sometimes life-saving therapy. This atlas presents high-quality images of a variety of rashes that have an infectious etiology and are commonly associated with fever.

###### Figure e7-1

Lacy reticular rash of erythema infectiosum (fifth disease) caused by parvovirus B19.

###### Figure e7-2

Koplik's spots, which manifest as white or bluish lesions with an erythematous halo on the buccal mucosa, usually occur in the first two days of measles symptoms and may briefly overlap the measles exanthem. The presence of the erythematous halo differentiates Koplik's spots from Fordyce's spots (ectopic sebaceous glands), which occur in the mouths of healthy individuals. (Source: Centers for Disease Control and Prevention.)

###### Figure e7-3

In measles, discrete erythematous lesions become confluent on the face and neck over 2&ndash;3 days as the rash spreads downward to the trunk and arms, where lesions remain discrete. (Reprinted from K Wolff, RA Johnson: Color Atlas & Synopsis of Clinical Dermatology, 5th ed. New York, McGraw-Hill, 2005, p 788.)

###### Figure e7-4

In rubella, an erythematous exanthem spreads from the hairline downward and clears as it spreads. (Courtesy of Stephen E. Gellis, MD; with permission.)

###### Figure e7-5

Exanthem subitum (roseola) occurs most commonly in young children. A diffuse maculopapular exanthem follows resolution of fever. (Courtesy of Stephen E. Gellis, MD; with permission.)

###### Figure e7-6

Erythematous macules and papules are apparent on the trunk and arm of this patient with primary HIV infection.(Reprinted from K Wolff, RA Johnson: Color Atlas & Synopsis of Clinical Dermatology, 5th ed. New York, McGraw-Hill, 2005.)

###### Figure e7-7

This exanthematous, drug-induced eruption consists of brightly erythematous macules and papules, some of which are confluent, distributed symmetrically on the trunk and extremities. Ampicillin caused this rash. (Reprinted from K Wolff, RA Johnson: Color Atlas & Synopsis of Clinical Dermatology, 5th ed. New York, McGraw-Hill, 2005.)

###### Figure e7-8

Erythema migrans is the early cutaneous manifestation of Lyme disease and is characterized by erythematous annular patches, often with a central erythematous papule at the ...

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