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== Differential diagnosis of causes of a rash and fever==  
==Overview==


In alphabetical order <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
[[Rash]] with [[Fever]] can occur in patients of all ages<ref name="pmid33187046">{{cite journal| author=Prakash N, Prakash J| title=Fever with Rash: A Clinical Dilemma. | journal=J Assoc Physicians India | year= 2020 | volume= 68 | issue= 11 | pages= 77-78 | pmid=33187046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33187046  }} </ref>. [https://www.cdc.gov 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 [[Fever and rash in children|in children]] as well as adults. In adults, it can occur due to multiple etiologies such as [[allergic reactions]], [[Immune disorders]], [[infections]], etc. <ref name="pmid30981291">{{cite journal| author=Muzumdar S, Rothe MJ, Grant-Kels JM| title=The rash with maculopapules and fever in adults. | journal=Clin Dermatol | year= 2019 | volume= 37 | issue= 2 | pages= 109-118 | pmid=30981291 | doi=10.1016/j.clindermatol.2018.12.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30981291  }} </ref> <ref name="pmid23197907">{{cite journal| author=Tabak F, Murtezaoglu A, Tabak O, Ozaras R, Mete B, Kutlubay Z | display-authors=etal| title=Clinical features and etiology of adult patients with Fever and rash. | journal=Ann Dermatol | year= 2012 | volume= 24 | issue= 4 | pages= 420-5 | pmid=23197907 | doi=10.5021/ad.2012.24.4.420 | pmc=3505772 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23197907  }} </ref>. The infectious agents often trigger rash by mode of a [[toxin]] or an [[Immune reaction|immunogenic reaction]] to the [[antigens]]. Infectious agents associated with fever with rash in adults can be [[Viruses|viral]] or [[Bacteria|bacterial]]. Some examples of such organisms are the [[Rubeola|Rubeola virus]], [[Staphylococcus aureus]], [[Borrelia burgdorferi]]. Among allergic reactions, adverse drugs reactions are the ones most commonly associated with Rash with Fever<ref name="pmid28515609">{{cite journal| author=Pannu AK, Adarsh MB, Sharma N| title=Not all febrile critical illness with rash is infective: Drug reaction may be a mimic. | journal=Indian J Crit Care Med | year= 2017 | volume= 21 | issue= 4 | pages= 229-231 | pmid=28515609 | doi=10.4103/ijccm.IJCCM_397_16 | pmc=5416792 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28515609  }} </ref>. 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<ref name="pmid33187046">{{cite journal| author=Prakash N, Prakash J| title=Fever with Rash: A Clinical Dilemma. | journal=J Assoc Physicians India | year= 2020 | volume= 68 | issue= 11 | pages= 77-78 | pmid=33187046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33187046  }} </ref>.


==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|Staphylococcal Scalded Skin Syndrome]] causes by [[Staphylococcus aureus]]
*[[Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis-Steven Johnson syndrome]] (TEN-SJS)
*[[Toxic shock syndrome|Toxic Shock syndrome]] caused by [[Staphylococci]] or [[Streptococcus|Streptococci]]
===Common causes===
*[[Adult-onset Still's disease|Adult-onset Stills disease]]
*[[Adverse drug reactions|Drugs reactions]]<ref name="pmid28954636">{{cite journal| author=Ros MM, Delsing CE| title=[A woman with fever and a rash]. | journal=Ned Tijdschr Geneeskd | year= 2017 | volume= 161 | issue=  | pages= D1118 | pmid=28954636 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28954636  }} </ref>
*[[Infectious Mononucleosis]]
*[[Measles|Measles/ Rubeola]]
*Rickettsial infections<ref name="pmid32352736">{{cite journal| author=Pace EJ, O'Reilly M| title=Tickborne Diseases: Diagnosis and Management. | journal=Am Fam Physician | year= 2020 | volume= 101 | issue= 9 | pages= 530-540 | pmid=32352736 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32352736  }} </ref> such as [[Lyme disease]], [[Rocky Mountain spotted fever]]
*[[Systemic Lupus Erythematosus (SLE)|Systemic Lupus Erythematosus]]
*[[West Nile Fever]]
<br />
===Less common causes===
*[[COVID-19]](SARS CoV-2)<ref name="pmid32330336">{{cite journal| author=Amatore F, Macagno N, Mailhe M, Demarez B, Gaudy-Marqueste C, Grob JJ | display-authors=etal| title=SARS-CoV-2 infection presenting as a febrile rash. | journal=J Eur Acad Dermatol Venereol | year= 2020 | volume= 34 | issue= 7 | pages= e304-e306 | pmid=32330336 | doi=10.1111/jdv.16528 | pmc=7267606 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330336  }} </ref>
*[[Dengue fever]]<ref name="pmid33281008">{{cite journal| author=Pastor Bandeira I, Sordi Chara B, Meneguzzi de Carvalho G, Magno Gonçalves MV| title=Diffuse skin rash in tropical areas: Dengue fever or COVID-19? | journal=An Bras Dermatol | year= 2020 | volume=  | issue=  | pages=  | pmid=33281008 | doi=10.1016/j.abd.2020.10.001 | pmc=7670906 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33281008  }} </ref>
*[[Dermatomyositis]]
*[[Graft-versus-host disease|Graft vs Host reaction]]
*[[HIV AIDS|Acute HIV infection]]<ref name="pmid27929236">{{cite journal| author=Konheim A, Watts PJ, Tacastacas JD| title=Fever and Rash in a Patient with HIV Infection. | journal=Am Fam Physician | year= 2016 | volume= 94 | issue= 8 | pages= 658-660 | pmid=27929236 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27929236  }} </ref>
*[[Parvovirus B19]]
*[[Pyoderma gangrenosum]]
*[[Sweet's syndrome|Sweet Syndrome]]
*[[Typhoid fever]]
*[[Syphilis]]<ref name="pmid26219059">{{cite journal| author=Clement ME, Okeke NL, Hicks CB| title=Fever and Rash in a Patient With Hepatitis. | journal=JAMA | year= 2015 | volume= 314 | issue= 4 | pages= 400-1 | pmid=26219059 | doi=10.1001/jama.2015.3401 | pmc=6612369 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26219059  }} </ref>
<br />
===Causes by Organ system===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |No underlying causes
|-
| bgcolor="LightSteelBlue" |'''Chemical/Poisoning'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |Toxic Epidermal Necrolysis; Drug eruptions; Steven Johnson syndrome
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |Lymphoma
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |Various viral and bacterial agents eg Zika, Dengue, Roseola, Typhoid, Parvovirus B19, Meningococci, Staphylococci
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal/Orthopedic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional/Metabolic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |Paraneoplastic syndrome
|- bgcolor="LightSteelBlue"
|'''Ophthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose/Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Renal/Electrolyte'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" |SLE; Adult-Onset Still's disease; Dermatomyositis
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |No underlying causes
|-
|}
===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
*[[Borrelia burgdorferi|Borrelia Burgdorferi]]
*[[Drug reaction]]s
*[[Drug reaction]]s
*[[Fifth disease]]
*[[Fifth disease]]
Line 33: Line 178:
*[[Varicella]]
*[[Varicella]]
*[[exanthem|Viral exanthem]]s
*[[exanthem|Viral exanthem]]s
== History and Symptoms ==
*Focused history is essential as fever w/ rash has many causes
*Determine toxicity
*A quick determination of RMSF and meningococcemia are important for immediate therapy
== Laboratory Findings ==
*Labs include
:*Bacterial cultures from any wounds
:*Toxic patients - blood cultures
:*[[Meningococcemia]] (suspected) - Lumbar puncture
:*Antibody titers confirm [[RMSF]]
:*[[Skin biopsy]] can determine [[vasculitis]] and detect rickettsial organisms in [[endothelium]]
:*TSS - Wound cultures with growth of staph or strep
== Treatment ==
The most important thing is to evaluate the most dangerous diagnosis, then use "watch and wait" for less serious symptoms
== Pharmacotherapy ==
=== Acute Pharmacotherapies ===
*RMSF - [[Doxycycline]]
*Meningococcal - [[Ceftriaxone]]


==References==
==References==
{{Reflist|2}}
{{reflist|2}}
 
 
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[[Category:Medical signs]]
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[[Category:Dermatology]]
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[[Category:Rheumatology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]

Latest revision as of 13:44, 18 January 2021
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.


Common causes


Less common causes


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]

References

  1. ↑ 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).
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Ros MM, Delsing CE (2017). "[A woman with fever and a rash]". Ned Tijdschr Geneeskd. 161: D1118. PMID 28954636.
  6. ↑ Pace EJ, O'Reilly M (2020). "Tickborne Diseases: Diagnosis and Management". Am Fam Physician. 101 (9): 530–540. PMID 32352736 Check |pmid= value (help).
  7. ↑ 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).
  8. ↑ 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).
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  12. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X


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