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Cutaneous Conditions in Febrile PatientsAka: Dermatologic Manifestations in Patients with Fever, Rash in the Febrile Patient, Febrile Patient with Rash, Fever and Rash, Febrile Eruption, Viral Exanthem

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  1. See Also
    1. Cutaneous Conditions in Febrile Returning Traveler
    2. Skin Infection (e.g. Cellulitis)
  2. Classic Exanthems (historical order of first identified)
    1. First: Rubeola (Measles)
    2. Second: Scarlet Fever (Streptococcus Pyogenes)
    3. Third: Rubella (German Measles)
    4. Fourth: Dukes' Disease (Coxsackievirus or Echovirus)
    5. Fifth: Fifth Disease (Erythema Infectiosum, Parvovirus)
    6. Sixth: Exanthem Subitum (Roseola Infantum, HH6-7)
  3. Distribution of Febrile Eruption
    1. Central Eruptions (starts with head and neck)
      1. Viral Exanthem
        1. Rubeola
        2. Rubella
        3. Parvovirus B19 (Erythema Infectiosum)
        4. Roseola Infantum
      2. Lyme Disease (Erythema Migrans)
      3. Drug eruption
    2. Peripheral Eruptions (starts on distal extremities)
      1. Erythema Multiforme
      2. Secondary Syphilis
      3. Meningococcemia
      4. Rocky Mountain Spotted Fever
      5. Dengue Fever
  4. Petechial Eruptions in the Febrile Patient
    1. Common and Urgent Causes
      1. Meningococcemia
      2. Rocky Mountain Spotted Fever
    2. Viral Causes
      1. Coxsackievirus A9
      2. Echovirus 9
      3. Epstein-Barr Virus
      4. Cytomegalovirus
      5. Atypical Measles
      6. Viral Hemorrhagic Fever
        1. Arbovirus Infection
        2. Arenavirus Infection
    3. Other Causes
      1. Disseminated Gonococcus
      2. Staphylococcemia
      3. Thrombotic Thrombocytopenic Purpura
  5. Diffuse Erythema and Desquamation in the Febrile Patient
    1. Most Common
      1. Scarlet Fever
      2. Kawasaki's Disease
      3. Toxic Shock Syndrome
      4. Scalded Skin Syndrome
    2. Less Common
      1. Ehrlichiosis
      2. Streptococcus viridans bacteremia
      3. Enteroviral infection
      4. Toxic epidermal necrolysis
      5. Graft-versus-host reaction
      6. Erythroderma
      7. Generalized pustular Psoriasis (von Zumbusch)
  6. Vesiculobullous Eruptions in the Febrile Patient
    1. Common
      1. Varicella Zoster Virus (Chicken Pox)
      2. Herpes Zoster (Shingles)
    2. Less common
      1. Staphylococcal Bacteremia
      2. Gonococcemia
    3. Immunocompromised Patient Causes
      1. Disseminated Herpes Simplex Virus
      2. Vibrio vulnificus (seafood exposure)
      3. Rickettsia akari
  7. Nodular Eruptions in the Febrile Patient
    1. Erythema Nodosum
    2. Disseminated fungal infection (Immunocompromised)
      1. Disseminated Candidiasis
      2. Cryptococcosis
      3. Blastomycosis
      4. Histoplasmosis
      5. Coccidioidomycosis
      6. Sporotrichosis
    3. Other rare causes
      1. Nocardia
      2. Pseudomonas
      3. Mycobacterium species
  8. References
    1. Cunha (1998) Crit Care Clin 14:35
    2. McKinnon (2000) Am Fam Physician 62(4):804
    3. Schlossberg (1996) Infect Dis Clin North Am 10:101

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