Rash with fever
 |
Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lovepreet Randhawa
Overview
Rash with Fever can occur in patients of all ages[1]. Centers for Disease Control and prevention(CDC) defines a person to have a fever when "he or she has a measured temperature of 100.4° F (38° C) or greater, or feels warm to the touch, or gives a history of feeling feverish." It is a common finding in children as well as adults. In adults, it can occur due to multiple etiologies such as allergic reactions, Immune disorders, infections, etc. [2] [3]. The infectious agents often trigger rash by mode of a toxin or an immunogenic reaction to the antigens. Infectious agents associated with fever with rash in adults can be viral or bacterial. Some examples of such organisms are the Rubeola virus, Staphylococcus aureus, Borrelia burgdorferi. Among allergic reactions, adverse drugs reactions are the ones most commonly associated with Rash with Fever[4]. The clinical condition of the patient can range from mild flu-like symptoms in Lyme's disease to severe life-threatening situations such as Toxic shock syndrome caused by Staphylococcus aureus[1].
Causes
Life threatening causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Acute meningococcemia by Neisseria Meningitidis
- Staphylococcal Scalded Skin Syndrome causes by Staphylococcus aureus
- Toxic Epidermal Necrolysis-Steven Johnson syndrome (TEN-SJS)
- Toxic Shock syndrome caused by Staphylococci or Streptococci
Common causes
- Adult-onset Stills disease
- Drugs reactions[5]
- Infectious Mononucleosis
- Measles/ Rubeola
- Rickettsial infections[6] such as Lyme disease, Rocky Mountain spotted fever
- Systemic Lupus Erythematosus
- West Nile Fever
Less common causes
- COVID-19(SARS CoV-2)[7]
- Dengue fever[8]
- Dermatomyositis
- Graft vs Host reaction
- Acute HIV infection[9]
- Parvovirus B19
- Pyoderma gangrenosum
- Sweet Syndrome
- Typhoid fever
- Syphilis[10]
Causes by Organ system
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Toxic Epidermal Necrolysis; Drug eruptions; Steven Johnson syndrome |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | Lymphoma |
| Iatrogenic | No underlying causes |
| Infectious Disease | Various viral and bacterial agents eg Zika, Dengue, Roseola, Typhoid, Parvovirus B19, Meningococci, Staphylococci |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | Paraneoplastic syndrome |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | SLE; Adult-Onset Still's disease; Dermatomyositis |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order[11][12]
- Borrelia Burgdorferi
- Drug reactions
- Fifth disease
- Measles
- Meningococcemia
- Parvovirus
- Rocky Mountain Spotted Fever
- Rubella
- Staphylococcus aureus
- Toxic Shock Syndrome
- Varicella
- Viral exanthems
References
- ↑ 1.0 1.1 Prakash N, Prakash J (2020). "Fever with Rash: A Clinical Dilemma". J Assoc Physicians India. 68 (11): 77–78. PMID 33187046 Check
|pmid=value (help). - ↑ Muzumdar S, Rothe MJ, Grant-Kels JM (2019). "The rash with maculopapules and fever in adults". Clin Dermatol. 37 (2): 109–118. doi:10.1016/j.clindermatol.2018.12.004. PMID 30981291.
- ↑ Tabak F, Murtezaoglu A, Tabak O, Ozaras R, Mete B, Kutlubay Z; et al. (2012). "Clinical features and etiology of adult patients with Fever and rash". Ann Dermatol. 24 (4): 420–5. doi:10.5021/ad.2012.24.4.420. PMC 3505772. PMID 23197907.
- ↑ Pannu AK, Adarsh MB, Sharma N (2017). "Not all febrile critical illness with rash is infective: Drug reaction may be a mimic". Indian J Crit Care Med. 21 (4): 229–231. doi:10.4103/ijccm.IJCCM_397_16. PMC 5416792. PMID 28515609.
- ↑ Ros MM, Delsing CE (2017). "[A woman with fever and a rash]". Ned Tijdschr Geneeskd. 161: D1118. PMID 28954636.
- ↑ Pace EJ, O'Reilly M (2020). "Tickborne Diseases: Diagnosis and Management". Am Fam Physician. 101 (9): 530–540. PMID 32352736 Check
|pmid=value (help). - ↑ Amatore F, Macagno N, Mailhe M, Demarez B, Gaudy-Marqueste C, Grob JJ; et al. (2020). "SARS-CoV-2 infection presenting as a febrile rash". J Eur Acad Dermatol Venereol. 34 (7): e304–e306. doi:10.1111/jdv.16528. PMC 7267606 Check
|pmc=value (help). PMID 32330336 Check|pmid=value (help). - ↑ Pastor Bandeira I, Sordi Chara B, Meneguzzi de Carvalho G, Magno Gonçalves MV (2020). "Diffuse skin rash in tropical areas: Dengue fever or COVID-19?". An Bras Dermatol. doi:10.1016/j.abd.2020.10.001. PMC 7670906 Check
|pmc=value (help). PMID 33281008 Check|pmid=value (help). - ↑ Konheim A, Watts PJ, Tacastacas JD (2016). "Fever and Rash in a Patient with HIV Infection". Am Fam Physician. 94 (8): 658–660. PMID 27929236.
- ↑ Clement ME, Okeke NL, Hicks CB (2015). "Fever and Rash in a Patient With Hepatitis". JAMA. 314 (4): 400–1. doi:10.1001/jama.2015.3401. PMC 6612369 Check
|pmc=value (help). PMID 26219059. - ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X