Fever and Rash - DONE Flashcards
Macules:
flat lesions defined by an area of changed color (i.e. blanchable erythema)
Blanchable erythema is a…
macule
Papules:
raised, solid lesions < 5 mm in diameter
Plaques:
lesions > 5 mm in diameter with a flat, plateau-like surface
Nodules:
lesions, > 5 mm in diameter with a more rounded configuration
Wheals =
- urticaria
- hives
Wheals:
- papules or plaques that are pale pink and may appear annual (ring-like) as they enlarge;
- classic (nonvasculitis) wheals are transient, lasting only 24h in any defined area
Vesicles size:
< 5 mm
Bullae size:
> 5 mm
Vesicles and bullae:
circumscribes, elevated lesions containing fluid
Pustules:
raising lesions containing purulent exudate
Nonpalpable purpura:
flat lesion that is due to bleeding into the skin.
- If < 3 mm in diameter, the purpuric lesions are termed PETECHIAE.
- If > 3 mm, they are termed ECCHYMOSES
Palpable purpura:
raised lesion that is due to inflammation of the vessel wall (vasculitis) with subsequent hemorrhage
Ulcer:
defect in the skin extending at least into the upper layer of the dermis
Eschar:
necrotic lesion covered with a black crust
Rubeola =
measles
Rubeola (measles):
- Paramyxovirus
- Discrete lesions that become confluent as rash spreads from hairline downward, usually sparing palms and soles; lasts >=3 days; Koplik’s spots
Rubella:
- Togavirus
- spreads from hairline download, clearing as it spreads; Forschheimer spots
Erythema infectiosum:
- Human parvovirus B19
- Bright-red “slapped-cheeks” appearance followed by lacy reticular rash that waxes and wanes over 3 weeks; rarely, papular-purpuric “gloves-and-socks” syndrome hands and feet
Primary HIV infection:
- HIV
- Nonspecific diffuse macules and papules; less commonly, urticarial or vesicular oral or genital ulcers
infectious mononucleosis
- Epstein-Barr virus
- Diffuse maculopapular eruption (5% of cases; 90% if ampicillin is given);
urticaria, petechiae in some cases; perobital oedema (50%); palatal petechiae (25%)
Exanthematous drug-induced eruption:
- drugs (antibiotics, anticonvulsants, diuretics, etc)
- Intensely pruritic, bright-red macules and papules, symmetric on trunk and extremities; may become confluent
Lyme disease:
- Borrelia burgdorferi
- Papule expanding to erythematous annular lesion with central clearing (erythema migrans; average diameter, 15 cm), sometimes with concentric rings, sometimes with indurated or vesicular center; multiple secondary erythema migrans lesions in some cases
Typhoid fever:
- Salmonella typhi
- Transient, blanchable erythematous macules and papules, 2-4 mm, usually on trunk (rose spots)
What illness gives rose spots?
Typhoid fever
Dengue fever:
- Dengue virus
- Rash in 50% of cases; initially diffuse flushing; midway through illness, onset of maculopapular rash, which begins on trunk and spreads centrifugally to extremities and face; pruritus, hyperesthesia in some cases; after defervescence, petechiae on extremities in some cases
Rat-bite fever:
- Spirillum minus
- Eschar at bite site; then blotchy violaceous red-brown rash involving trunk and extremities
Systemic lupus erythematous:
- autoimmune disease
- macular and papular erythema, often in sun-exposed areas;
discoid lupus lesions (local atrophy, scale, pigmentary changes);
periungual teleangiectasis; malar rash;
vasculitis sometimes causing urticaria, palpable purpura;
oral erosions in some cases
Still´s disease
- autoimmune disease
- transient 2- or 5-mm erythrmatous papules appearing at height of fever on trunk, proximal extremities; lesions evanescent
Secondary syphilis:
- Treponema pallidum
- Coincident primary chancre in 10% of cases;
copper-colored, scaly papular eruption, diffuse but prominent on palms and soles;
rash never vesicular in adults;
condyloma latum, mucous patches, and alopecia in some cases
Chikungunya fever:
- Chikungunya virus
- maculopapular eruption; prominent on upper extremities and face, but can also occur on trunk and lower extremitites
Hand-foot-and-mouth-disease:
- coxsackie virus
- tender vesicles, erosions in mouth; 0,25 cm papules on hands and feet with rim of erythema evolving into tender vesicles
Erythema multiforme (EM)
- Infection, drugs, idiopathic causes
- Target lesions (entral erythema surounded by area of clearing and another rim of erythema) up to 2 cm; symmetric on knees, elbows, palms, soles;
spreads centripetally;
papular, sometimes vesicular;
when extensive and involving mucous membrane, termed EM major.
Bacterial endocarditis - cause:
- strep
- staph
Subacute course - Bacterial endocarditis:
Osler´s nodes (tender pink nodules on finger or toe pads);
Petechiae on skin and mucosa; splinter hemorrhages
Acute course - Bacterial endocarditis:
Janeway lesions (painless erythematous or hemorrhagic macules, usually on palms and soles)
Scarlet fever:
- group A strep
- Diffuse blanchable erythema begining on face and spreading to trunk and extremities; circumoral pallor;
„sandpaper” texture to skin;
accentuation of linear erythema in skin folds (Pastia’s lines);
enanthem of white evolving into red „stawberry” tongue; desquamation in second week
Kawasaki disease:
- idiopathic causes
- rash similar to scarlet fever or EM;
fissuring on lips; strawberry tongue;
conjunctivitis;
edema of hands, feet;
desquamation later in disease
Streptococcal toxic shock syndrome:
- group A strep
- when present, rash often scarlatiniform
- staph aureus
- Diffuse erythema involving palms;
pronounced erythema of mucosal surfaces;
conjunctivitis;
desquamation 7-10 days into illness
Staphylococcal scalded-skin syndrome:
- s.aureus, phage group II
- Diffuse tender erythema, often with bullae and desquamation; Nikolsky´s sign
Dress =
Dihs
Dress (Dihs)
- Aromatic anticonvulsants;
other drugs, including sulfonamides, minocycline - Maculopapular eruption (mimicking exanthematous drug rash), sometimes progressing to exfoliative erythroderma;
profound edema, especially facial;
pustules may occur
Steven-Johnson syndrome (SJS), toxic epidermal necrolysis (ten)
- Drugs (80% of cases;
often allopurinol, anticonvulsants, antibiotics), infection, idiopathic - Erythematous and purpuric macules, sometimes targetoid, or diffuse erythema progressing to bullae, with sloughing and necrosis of entire epidermis;
Nikolsky’s sign; involves mucosal surfaces;
TEN (>30% epidermal necrosis) is maximal form;
SJS involves <10% of epidermis; STS/TEN overlap involves 10-30% of epidermis
Varicella (chickenpox):
- VZV
- Macules (2-3 mm) evolving into papules, then vesicles (sometimes umbilicated), on an erythematous base („dewdrops on a rose petal”); pustules then forming and crusting; lesions appearing in crops; may involve scalp, mouth; intensely pruritic
Variola =
smallpox
Variola (smallpox):
- variola major virus
- Red macules on tongue and palate evolving to papules and vesicles;
skin macules evolving to papules, then vesicles over 1 week, with subsequent lesion crusting;
lesions initially appearing on face and spreading centrifugally from trunk
Primary herpes simplex virus (HSV- infection):
- HSV
- Erythema rapidly followed by hallmark painful GROUPED VESICLES that may evolve into pustules that ulcerate, especially on mucosal surfaces;
lesions at site of inoculation: commonly gingivostomatitis for HSV-1 and genital lesions for HSV-2;
recurrent disease milder (e.g., herpers labialis does not involve oral mucosa)
Urticarial vasculitis:
- Serum sickness, often due to infection (including hepatitis B viral, enteroviral, parasitic), drugs; connective tissue disease
- Erythematous, edematous „urticaria-like” plaques, pruritic or burning; unlike urticaria; typical lesion duration > 24 h (up to 5 days) and lack of complete lesion blanching with compression due to hemorrhage
Erythema nodosum (septal panniculitis):
- Infections (e.g. streptococcal, fungal, mycobacterial, yersinial);
drugs (e.g., sulfas, penicillins, oral contraceptives); sarcoidosis;
idiopathic causes - Large, violaceous, nonulcerative, subcutaneous nodules; exquisitely tender;
usually on lower legs but also on upper extremities.
Acute meningococcemia:
- Neisseria meningitidis
- Initially pink maculopapular lesions evoving into petechiae rapidly becoming numerous, sometimes enlarging and becoming vesicular;
trunk, extremities most commonly involved;
may appear on face, hands, feet;
may include purpura fulminans reflecting DIC
Cutaneous small - vesselvasculitis (leukocytoclastic vasculitis)
- Infections (including that caused by group A Streptococcus, viral hepatitis), drugs, idiopathic causes
- Palpable purpuric lesions appearing in crops on legs or other dependent areas;
may become vesicular or ulcerative
Anthrax:
- Bacillus anthracis
- Pruritic papule enlarging and evolving into a 1-by 3-cm painless ulcer surrounded by vesicles and then developing a central eschar with edema; residual scar
Erysipelas:
- Streptococcus group A
- Infection of the superficial dermis and consists of demarcated, erythematous, edematous, warm plaques
Herpes zoster:
- reactivation of varicella zoster virus (VZV)
- bubbles on one dermatomy, may be more than one dermatomy in immune deficiency.
