Fever + Rash Flashcards
Rash Hx features?
- Morphology
- Duration
- Distribution
- Known allergies / exposures
- Current and previous Rx
- Existing systemic conditions
- Possible infectious exposure
- F/O/S/T
- Hx pharyngitis / strep throat
- URTI - viral
Symptoms commonly associated with viral exanthema?
- Fever
- Malaise
- Pharyngitis
- Myalgia
Ddx of erythematous rash with unwell child / systemic involvement?
- urticaria of hypersensitivity
- scarlet fever
- SSSS
- TSS
- early SJS
- Rheumatic fever
- Juvenile arthritis
- SLE
- sarcoidosis
- Lyme disease
What are the possible features of rash due to hypersensitivity?
- generalised urticaria
- localised lesions e.g. if due to insect bites
- generalised swelling
- airway compromise
- hypotension
- tachycardia
What is the duration of urticarial lesions due to hypersensitivity reactions?
24 - 48h. Eruption may last longer due to recurrent crops of lesions
What is the description of scarlet fever rash?
- Sandpaper like generalised erythematous rash
- discrete skin coloured papules
- linear petechial streaks (Pastia lines) in skinfolds, esp of axillary, inguinal and antecubital fossae
What are the Hx features of scarlet fever rash?
- usually follows pharyngitis or tonsillitis
- young children
- common between autumn and spring
- positive contact history (2-5d before symptoms)
What PEx features may be associated with scarlet fever rash?
- tender cervical adenopathy
- pharyngeal erythema with exudates
- palatal petechiae
- red, swollen strawberry tongue
What is the description of SSSS rash?
- Generalised erythematous rash with skin exfoliation
- Fragile bullae on skin surface
- +ve Nikolsky sign
Superficial desquamation / exfoliation in 2-5d. Denuded and crusted underlying skin.
What is a positive Nikolsky sign?
blister induced with lateral pressure
Hx features of SSSS?
- Hx recent infection (skin / resp / GIT)
- usually 6 or younger
- Prodrome of fever, malaise, tender skin
What is the rash of TSS?
Diffuse, erythematous rash on trunk, palms and soles. Cutaneous desquamation 1-2w after onset, starting on palms and soles.
Clinical / Hx features of TSS?
- Hx recent surgery or super absorbent tampon use
- Systemic upset: fever, hTN, HA, confusion, malaise, pharyngitis, N/V/D.
How is TSS diagnosed?
Clinically in presence of fever and hypotension
What is the characteristic rash of SJS?
Targetoid lesions (annular erythematous rings with an outer erythematous zone and no central blistering sandwiching a zone of normal skin tone).
What is the rash of Rheumatic fever?
Erythema marginatum: fleeting pink rash typically involving the trunk and proximal extremities.
-subcut nodules may be present: firm and painless
What are the Hx features to elicit in Rheumatic fever rash prevention?
- recent sore throat
- prolonged fever
- migratory large joint tenderness
- CP
- dyspnoea
- Hx involuntary movements (Sydenham chorea)
- cardiac murmur or pericardial rub
What is the characteristic rash of juvenile arthritis?
- transient, erythematous non pruritic rash
- favours trunk and site of pressure
Hx feature of juvenile arthritis rash?
- Periodic fevers (often late afternoon, spiking in evening)
- joint pain
- myalgia
Rash of SLE?
-Malar butterfly rash
also
- discoid
- photosensitive rash
Hx features suggestive of SLE rash?
- Fever
- Fatigue
- Recurrent infeciton
- Arthralgias
- Malaise
- CP
PEx features suggestive of SLE?
- Arthritis
- Serositis
- HTN
- Oedema
- Hepatomegaly
- Splenomegaly
- Lymphadenopathy
