37 y/o F is seen for fever (102-103 degree F) of 2 weeks associated with joint pain. Patient also had maculopapular rash involving palms, sole, and extremities, but not in the trunk or face. Does have rash in mouth near soft palate, or hard palate junction. Vitals were stable other than HR of 105. No LN were enlarged. HIV and RPR were negative.
DDx of Fever with Rash - Centrally distributed maculopapular,
- rubeola (measles)
- Rubella (German measles)
- infectious mononucleosis
- primary HIV infection
- erythema infectious (fifth disease)
- Exanthem subitum (roseola)
- urticaria, exanthematous drug-induced eruptions
- Rickettsial illnesses
- Endemic typhus or leptospirosis
- typhoid fever
- Dengue fever,
- Lyme disease
- Southern tick-associated rash illness (STARI)
- Erythema marginatum
- systemic lupus erythematosus
- Still’s disease
- peripheral,
- Rocky Mountain spotted fever
- secondary syphilis
- Chikungunya fever
- Hand-foot-and-mouth disease
- erythema multiforme
- confluent desquamative erythematous,
- Scarlet fever
- Kawasaki disease
- Streptococcal toxic shock syndrome
- Staphylococcal toxic shock syndrome
- toxic epidermal necrolysis
- Stevens-Johnson syndrome
- Exfoliative erythroderma syndrome
- Drug rash with eosinophilia and systemic symptoms (DRESS)
- vesiculobullous,
- Varicella
- Pseudomonas “hot-tub” folliculitis
- variola (smallpox)
- Herpes simplex virus infection
- Rickettsialpox
- Acute generalized eruptive pustulosis
- Disseminated Vibrio vulnificus infection
- ecthyma gangrenosum due to Pseudomonas aeruginosa
- urticaria-like,
- urticarial vasculitis (when fever is present)
- Etiologies include serum sickness often induced by
- drugs such as penicillins, sulfas, salicylates, or barbiturates),
- connective-tissue disease (e.g., systemic lupus erythematosus or Sjögren’s syndrome), and
- infection (e.g., with hepatitis B virus, enteroviruses, or parasites).
- Malignancy, especially lymphoma, may be associated with fever and chronic urticaria
- nodular,
- Disseminated candidiasis
- Disseminated cryptococcosis
- molluscum contagiosum
- aspergillosis
- mucormycosis
- Erythema nodosum
- Sweet syndrome
- purpuric,
- Acute meningococcemia
- Rocky Mountain spotted fever
- Echovirus 9 infection
- Large ecchymotic areas of purport fulminates: DIC
- Chronic meningococcemia
- Disseminated gonococcemia
- Viral hemorrhagic fever
- Thrombotic thrombocytopenic purport and HUS
- Cutaneous small-vessel vasculitis
- ulcerated or with eschars
- scrub typhus or
- rickettsialpox
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