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.
Lacy reticular rash of erythema infectiosum (fifth disease) caused by parvovirus B19.
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.)
In measles, discrete erythematous lesions become confluent on the face and neck over 2–3 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.)
In rubella, an erythematous exanthem spreads from the hairline downward and clears as it spreads. (Courtesy of Stephen E. Gellis, MD; with permission.)
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.)
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.)
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.)
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 tick-bite site. (Courtesy of Yale Resident's Slide Collection; with permission.)
Rose spots are evident as erythematous macules on the trunk of this patient with typhoid fever. (Source: Centers for Disease Control and Prevention.)
Systemic lupus erythematosus showing prominent, scaly, malar erythema. Involvement of other sun-exposed sites is also common.
Acute lupus erythematosus on the upper chest, with brightly erythematous and slightly edematous coalescent papules and plaques. (Courtesy of Robert Swerlick, MD; with permission.)
Discoid lupus erythematosus. Violaceous, hyperpigmented, atrophic plaques, often with evidence of follicular plugging (which may result in scarring), are characteristic of this cutaneous form of lupus. (Courtesy of Marilynne McKay, MD; with permission.)
The rash of Still's disease typically exhibits evanescent, erythematous papules that appear at the height of fever on the trunk and proximal extremities. (Courtesy of Stephen E. Gellis, MD; with permission.)
Impetigo is a superficial group A streptococcal or Staphylococcus aureus infection consisting of honey-colored crusts and erythematous weeping erosions. Occasionally, bullous lesions may be seen. (Courtesy of Mary Spraker, MD; with permission.)
Erysipelas is a group A streptococcal infection of the superficial dermis and consists of well-demarcated, erythematous, edematous, warm plaques.
Top: Petechial lesions of Rocky Mountain spotted fever on the lower legs and soles of a young, otherwise healthy patient. Bottom: Close-up of lesions from the same patient. (Courtesy of Lindsey Baden, MD; with permission.)
Primary syphilis with a firm, nontender chancre.
Secondary syphilis, demonstrating the papulosquamous truncal eruption.
Secondary syphilis commonly affects the palms and soles with scaling, firm, red-brown papules.
Condylomata lata are moist, somewhat verrucous intertriginous plaques seen in secondary syphilis.
Mucous patches on the tongue of a patient with secondary syphilis. (Courtesy of Ron Roddy; with permission.)
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