Rashes with Fevers

A mother brings in her 5 year old daughter to the pediatrician because she had a sudden rash appear on her cheeks that had spread to her arms and trunk. She also reports that her child feels very warm. A couple of children in day care had similar symptoms

Erythema Infectiousus / Fifth disease Parvo B-19 virus infection spread by respiratory droplets Prodrome: low grade fever Slapped cheek erythema maculopapular rash on

extremities Take caution in patients with sickle cell anemia and pregnant

women Tx:

Supportive: antihistamine for puritus, and NSAIDS for pain relief Sickle cell might need transfusion

A 14 year old girl presents to the ED complaining of a painful red “bumps” on her shins. She says two weeks ago she had a sore throat and fever. During triage she is found to have a low grade fever.

Erythema Nodosum Inflammation of subcutaneous tissue reaction Red tender nodules Noninfectious causes

Sarcoidosis Rheumatic feverIrritable Bowl Disease Lupus Medications: sulfonamides, contraceptive pills

Infectious causesGroup A strep (strep pyogenes) Tuberculosis Fungi: Histoplasmosis, coccidioideomycosis

Erythema Marginatum of Rheumatic Fever

An 8 year old boy complains of itching. When his mom checks his back he has these lesions all over. Reviewing his chart you see that mom had refused vaccinations when he was 1 years old and has not gotten any after that.

Varicella/ Chicken Pox Herpes virus 3 Contagious 24 hours before rash and up until crusting of

lesions Prodrome: malaise, fever, myalgia Pruritic lesions appear in crops

Papules, vesicles on erythematous base, crusting Tx: supportive, can give acyclovir, antihistamine

A young couple brings their newly adopted 2-year-old son to the pediatrician because he has a temperature of 104 degrees F and a rash. The report that the rash began at his head and face and spread downward to include the hands and soles. The mother reports that prior to developing the rash the child had cough and red eyes

Measles /Rubeola Paramyxovirus Prodrome: cough, coryza, conjunctivitis, fever, malaise,

koplik spots Erythematous maculopapular rash starts on face and spread

down (cephalocaudal). Recovery also starts on face and spreads down

Tx: supportive Vitamin A

A 35-year-old woman has been refusing to vaccinate her children due to the claims that vaccinations may cause autism in children. Her 10-year-old male child began developing a low-grade fever with a rash that started on his face; as the rash began to spread to his limbs, it slowly disappeared from his face. When the child was taken to a clinic, the physician noticed swollen lymph nodes behind the ears of the child. What is the most likely cause of the rash?

Rubella/ German measles Rubella virus, togavirus Prodrome: generalized mild lymphadenopathy and fever Erythematous, maculopapular rash starts on face and

spreads downwards Erythema on soft palate (Forschheimer spots) Congenital rubella

Cataract DeafnessPatent ductus arteriosis, pulmonary artery hypoplasia/ stenosisHepatomegaly Microcephaly Blueberry muffin rash (thrombocytopenia)

A young child is brought to the pediatrician by his mother who reports that the boy has had a "sore throat" for two weeks and has recently developed a red flush in the skin with a bright red tongue. He is increasingly agitated and the rash appears to be spreading to his trunk.

Scarlet Fever Streptococcus pyogenes Erythematous tiny papular (sandpaper-like) rash with a

strawberry like tongue Trunk extremities Fever, sore throat, nausea Tx: penicillin

A 18-year-old female presents to the emergency room via ambulance after she began experiencing nausea, vomiting, and diarrhea this morning. Her mother reports that she began to complain of sudden-onset fever and chills that started earlier today, as well as the development of a sunburn-like rash. She had a severe nose bleed a day ago and used nasal packing in order to stop it. What is the most likely cause of her symptoms.

Toxic shock syndrome Staph Aureus preformed TSST-1 toxin Risk are tampons and nasal packing Sunburn-like rash desquamation on palms and soles Symptoms: >102 fever, hypotension, multisystem

involvement GI (vomiting and diarrhea) Myalgias (increase creatine kinase) Renal (BUN and Creatinine high) Hematologic ( Platelets <100KLiver (AST and ALT elevated)CNS: altered mental Tx: antibiotics that cover staph. IV fluids and pressors for hypotension

12-year-old boyscout who returned from a summer camping trip in Oklahoma one week ago presents with fever, lethargy, headache, and abdominal pain. Petechial lesions are noted on the palms of his hands and feet.

Rocky Mountain Spotted Fever Rickettsia rickettsii transmitted by tick Petechial rash that spreads centripetal (palms and

soleswrist and ankles trunk) Flu like symptoms Tx: doxycycline

A 16-year-old boy presents to his primary care physician with fatigue, headache, and arthralgia. The doctor identifies a ring-shaped lesion on his lower back.

Lyme Disease Borrelia Burgdorferi, transmitted by Ixodes tick Erythema chronicum migrans (explanding circle) Flu like symptoms Affects heart, joints, and CNS.

Bell’s palsy AV block Tx: oral doxycycline, amoxicillin, or cefuroxime

IV for neurological and cardiac forms ceftriaxone and penicillin

An 11-year-old boy presents to clinic with a rash on his feet. He complains of having a fever and feeling "itchy" the day before and having a sore throat. Physical exam reveals pharyngeal erythema and a few vesicles. He has a similar rash on his palms.

Hand Foot and Mouth Disease Coxsackie Type A Vesicular rash on palms, soles, and posterior pharynx. Associated symptoms: fever, sore throat Tx: supportive

A 4-year-old child develops a high fever and no other physical findings. On the third day of illness, the fever rapidly declines and a spotty, maculopapular rash develops on the trunk and spreads to the extremities. 

Roseola Infantum Herpes Virus 6 Prodorme: very high fever for about 3 days (risk of febrile

seizures) Diffuse maculopapular rash after the fever resolves Tx: Supportive with temperature control

A 15-year-old female is brought to the emergency room with high fever and confusion. She complains of chills and myalgias, and physical examination reveals a petechial rash

Meningococcemia N. meningitidis Abrupt onset of fever, chills, malaise and petechial/ purpura

rash Waterhouse-Friderichsen syndrome

Bilateral hemorrhage of adrenal glands Shock, DIC, coma, death in 6-8 hours

Tx: IV penicillin, cephalosporins if there is meningitis IV fluids for blood pressure support Corticosteroids if adrenals are affected FFP if DIC

A 15-year-old boy presents with 3 days of sore throat, fever, cervical lymphadenopathy, and generalized malaise. On exam he has a temperature of 102 F, BP 96/50, and a diffuse exudate on both tonsils. His mother had given him left over amoxicillin because she had thought he had strep throat He presents with this rash. What is the most likely cause?

Mononucleosis EBV Symptoms: fatigue, malaise, sore throat, cervical

lymphadenopathy, exudate on tonsils, splenomegaly, fever, chills,

Maculopapular rash with antibiotics Tx: supportive, counsel on avoiding contact sports

A 1 year old child is brought because of a fever and large blisters that break with slight pressure. The skin is erythematous and desquamating.

Scalded Skin Syndrome Staph aureus Exfoliative toxin targets desmoglein which is

important in cell to cell adhesion Prodrome: fever, irritability, and skin tenderness Erythema flaccid blisters desquamation + Nikolsky sign No mucosal involvement (differentiate from toxic epidermal

necrolysis) Tx: antibiotics that cover staph. IV fluids to prevent

dehydration.

A 8 year old child had a cold sore appear on this upper lip three days ago. The following day his mother also noted a rash on his palms, shown above.

Erythema Multiforme Target/bulls eye lesions Causes

Infections: Herpes Simplex Type 1, mycoplasma pneumoniae Medication: Beta-lactams, sulfa drugs, phenytoin Autoimmune disease

Tx: Antihistamines for pruritus Acetaminophen for fever Acyclovir if due to herpes

A 13-year-old girl re-presents to his pediatrician with a new onset rash that began a few days after his initial visit. She initially presented with complaints of sore throat but was found to have a negative strep test. Her mother demanded antibiotics, but since the doctor refused she have some penicillin she found left over in the cabinet at home. Shortly after starting the drug, the girl developed a fever and a rash seen above. Her skin begins to slough off, and the rash covers over 30% of her body. Her oropharynx and corneal membranes are also affected. You examine her at the bedside and note a positive Nikolsky's sign. What is the most likely diagnosis?

Steven Johnson Syndrome and Toxic Epidermal Necrolysis

Skin necrosis, bullae formation, sloughing of skin. Involves 2 or more mucosal surfaces Steven Johnsons involves <10% of total body surface Toxin Epidermal necrolysis involves >30% Death due to secondary infection and sepsis Tx:

Stopping medications that may have caused it Supportive: fluids, wound care, pain control, antihistamines for

pruritus, topical steroids to reduce inflammation

A 4-year-old boy presents to the urgent care center with 3 days of fever to 104 degrees F. On physical exam, he is noted to have conjunctivitis, an erythematous rash, cervical lymphadenopathy, and swollen hands and feet. His tongue is noted to be bright red. Labs are remarkable for an absolute neutrophilic leukocytosis, left-shift, and an elevated ESR. Plateletes are normal.

Kawasaki Vasculitis Symptoms

Fever >104 for 5 days Truncal rash Cervical lymph node >1.5cm Bilateral nonexudative conjunctivitis Mucositis, strawberry tongue, cracked lips Hand and foot edema and desquamation

Tx:IVIG and aspirin Affects coronary vessels leading to aneurysm