Clinical Perspectives in Skin Changes Flashcards
name the six diffuse maculopapular rashes
- measles
- rubella
- erythema infectiosum
- infectious mononucleosis
- lyme disease
- ehrlichiosis
in an unvaccinated patient, what is the time between exposure to measles and prodrome?
7-18 days
P STAR
brick red, irregular, maculopapular
appears 3-4 days after onset of prodrome
begins on the face and proceeds downward and outward
measles rash
predilection for face and neck, sparseness on the trunk
P STAR
describe the WBC in measles
leukopenia
describe the prodrome of measles
fever, cough, coryza, conjunctivitis
P STAR
where are koplik spots located? for which disease are they pathognomonic?
buccal mucosa, measles
[koplik spots occur 30% of the time]
P STAR
what are the severe complications of measles?
- pneumonia
2. post-measles encephalomyelitis
circumoral pallor
subsequent lacy, maculopapular, evanescent rash on the trunk and limps
malaise, HA, pruritus (palms and soles) but little fever
fiery red “slapped cheek” appearance
erythema infectiosum (an exanthematous illness)
what is one of the most common causes of myocarditis in children?
parvovirus
- transient, aplastic crisis and pure red blood cell aplasia may occur
- arthralgias uncommon in children
- rashes, esp. facial, uncommon in adults
- during pregnancy: premature labor, hydrops fetalis, fetal loss are reported sequelae
symptoms of parvovirus B19 infection can mimic those of what autoimmune states?
lupus, systemic sclerosis, antiphospholipid syndrome, vasculitis
MARKED
the rash of parvovirus can sometimes mimic urticaria and eczema due to…
immune deposition
what rickettisal infection is common in missouri?
ehrlichiosis
child in missouri presents with appendicitis-like abdominal pain, conjunctival injection, palatal petechiae, edema of dorsal hands, calf pain
fever, chills, HA, malaise, myalgia, N/V, anorexia, photophobia
what is your number one on the ddx? what will labs show? how many days after onset of systemic symptoms does the patient show cutaneous changes?
- ehrlichiosis (usually presents with flu-like symptoms)
- leukopenia, thrombocytopenia, lymphopenia, transaminitis, anemia
- erythematous macules and/or papules, petechiae, or diffuse erythema ~5 days days after onset of systemic symptoms
- *cough, dyspnea, respiratory insufficiency/adult RDS
- *meningoencephalitis, altered mental status, cranial or peripheral motor nerve paralysis, sudden transient deafness
- *acute renal failure, DIC, pericarditis
what is a severe neurological complication of ehrlichiosis?
what are three other severe complications?
meningoencephalitis
if prolonged: acute renal failure, DIC, pericarditis
name the lesion and disease:
flat or slightly raised red lesions that expands with central clearing
erythema migrans; lyme disease
describe stage 1 of lyme disease
early localized infection:
erythema migrans at bite site ~1 week following (can be up to one month after); common areas are groin, axilla, thigh
concomitant viral-like illness: myalgias, arthritis, HA, fatigue +/- fever
describe stage 2 of lyme disease
early disseminated infection (weeks-months later):
myopericarditis w/ atrial or ventricular arrhythmias; heart block in 4-10% of pts
conjunctivitis, keratitis; possible neurologic manifestations
bacteremia
secondary skin lesions w/in days-weeks of original infxn, similar to primary lesion but smaller
malaise, fatigue, fever, HA, neck pain, generalized achiness
a patient has myopericarditis w/ atrial or ventricular arrythmias, and heart block. what stage of lyme disease do you suspect?
stage 2 - early disseminated infection
describe stage 3 of lyme disease
late persistent infection (months-years):
60% polyarthritis; 10% develop chronic arthritis
ACA - cutaneous, bluish-red discoloration of distal extremity w/ assoc. swelling; lesions atrophic and sclerotic (resemble localized scleroderma)
a patient w/ known history of lyme disease follows up at your office
on PE you notice cutaneous, bluish-red discoloration of distal extremity w/ assoc. swelling; lesions atrophic and sclerotic
what is the name of this?
acrodermatitis chronicum atrophicans / ACA
this occurs in stage 3 (late persistent infection)
how do you differentiate between vesicle formation in lyme disease from that of shingles?
lyme disease will not follow dermatomal distributions
pt presents w/ malaise, fever, exudative sore throat
palatal petechiae, LAD, splenomegaly, maculopapular rash
heterophile agglutination test is positive
how does the blood smear look?
infectious mononucleosis (+ monospot)
blood smear will have atypical, large lymphocytes; lymphocytosis
LAD – discrete, nonsuppurative, slightly painful, esp. along posterior cervical chain
note: conjunctival hemorrhage, uvular edema, tonsillitis, or gingivitis may occur
name a few complications of infectious mononucleosis
hepatitis, myocarditis, neuropathy, encephalitis, airway obstruction from adenitis, hemolytic anemia, thrombocytopenia
what is the hoagland sign?
transient bilateral upper lid edema, seen in infectious mononucleosis