exanthem with islands of sparing (‘white islands in a sea of red’)
Clin Inf Dis 36:1004–1005,1074–1075, 2003; clinical differential
diagnosis includes typhoid fever, leptospirosis, meningococcal
disease, streptococcal disease, staph, rickettsial disease,
malaria, arbovirus (chikungunya, o’nyon nyong fevers),
Kawasaki’s disease
Drug eruptions
Ebola viral hemorrhagic fever – morbilliform rash
MMWR
44:468–469, 1995
Epidemic typhus (
Rickettsia prowazeki ) (body louse) – pink
macules on sides of trunk,
spreads centrifugally; flushed face
with injected conjunctivae; then rash becomes deeper red,
then purpuric; gangrene of finger, toes, genitalia, nose
JAAD
2:359–373, 1980; transient red rash of trunk and face Clin Inf
Dis 32:979–982, 2001; Brill–Zinsser disease – recrudescence of
epidemic typhus
Filoviruses – Marburg and Ebola virus; transient morbilliform
rashes, purpura,
red eyes
JAAD 49:979–1000, 2003
Hantavirus – infected rodent waste; flulike prodrome; nausea,
vomiting, shock, extensive ecchymoses; oliguria, pulmonary
edema, coagulopathy
AD 140:656, 2004
Hemorrhagic fevers
HTLV-1 infection – infective dermatitis of scalp, eyelid margins,
perinasal skin, retro-auricular areas, axillae, groin; generalized
papular dermatitis
Lancet 336:1345–1347, 1990; BJD
79:229–236, 1967; BJD 78:93–100, 1966
Infectious mononucleosis
Izumi fever
Kaposi’s
varicelliform eruption
Kenya tick typhus – R. conorii
Kyasanur Forest disease (Flavivirus)
Lassa fever (arenavirus) – morbilliform or petechial rash with
conjunctivitis
J Infect Dis 155:445–455, 1985
Leptospirosis
Leishmaniasis – disseminated leishmaniasis
JAAD 50:461–465,
2004; post-kala-azar dermal leishmaniasis – papules of cheeks,
chin, ears, extensor forearms, buttocks, lower legs; in India,
hypopigmented macules; nodules develop after years; tongue,
palate, genitalia
Rook p.1419–1420, 1998,
Sixth Edition;
JAAD 34:257–272, 1996; E Afr Med J 63:365–371, 1986
Leprosy – including erythema nodosum leprosum
AD 111:1575–1580, 1975
Leptospirosis – morbilliform
J Clin Inf Dis 21:1–8, 1995; truncal
red morbilliform, urticarial, pretibial, purpuric desquamative
exanthem
Tyring p.436, 2002; pretibial
fever or canicola
fever – blotchy erythema of legs
Rook p.1162, 1998, Sixth
Edition
Malaria
Marburg virus (filovirus) – maculopapular–vesicular
Tyring
p.423, 2002; S Afr Med J 60:751–753, 1981
Marseilles fever –
Rickettsia conorii
Mayaro – arbovirus; Brazil and Trinidad
Tyring p.399, 2002
Measles
Mediterranean spotted fever –
Rickettsia conorii; petechiae
JAAD 49:363–392, 2003
Melioidosis
Meningococcemia
Monkeypox – exanthem indistinguishable from smallpox
(papulovesiculopustular)
J Infect Dis 156:293–298, 1987
Murine typhus –
Rickettsia typhi and ELB agent – blanching
macular or morbilliform rash
MMWR 52:1224–1226, 2003;
J Clin Inf Dis 21:991, 1995
Mycobacterium tuberculosis – lichen scrofulosorum Ped
Derm 17:373–376, 2000; AD 124:1421–1426, 1988;
Clin Exp Dermatol 1:391–394, 1976
North Asian tick-borne typhus –
Rickettsia siberica
Omsk hemorrhagic fever (Flavivirus)
AD 140:656, 2004
Onchocerciasis – acute papular onchodermatitis – non-specific
papular rash
Rook p.1381, 1998, Sixth Edition; BJD
121:187–198, 1989
ONN – arbovirus; morbilliform eruption, fever, arthritis
Tyring
p.399, 2002
Parvovirus B19
Penicillium marneffei – generalized papular eruption Lancet
344:110–113, 1994; Mycoses 34:245–249, 1991
Picornavirus
Skin and Allergy News 30:38,1999
Plague (
Yersinia pestis) – macular, red, petechial or purpuric
eruption (black death)
West J Med 142:641–646, 1985
Q fever –
Coxiella burnetii; red macules, morbilliform, papular,
urticarial, and purpuric eruptions
JAAD 49:363–392, 2003;
Pediatr Inf Dis J 19:358, 2000
Queensland tick typhus –
Rickettsia australis
Rat bite fever
Roseola
Rubella
Scarlet fever
Schistosomiasis – schistosomal dermatitis –
identical to
swimmer’s itch
Dermatol Clin 7:291–300, 1989; Schistosoma
japonicum – Katayama fever – purpura, arthralgia, systemic
symptoms
Dermatol Clin 7:291–300, 1989
Scrub typhus (
Rickettsia tsutsugamuchi ) (mites) – headache
and conjunctivitis; eschar with black crust; generalized macular
or morbilliform rash
Clin Inf Dis 18:624, 1994; JAAD 2:359–373,
1980
Sepsis
Sindbis – arbovirus; fever, rash, arthritis; Europe, Asia, Africa,
Australia
Tyring p.399, 2002
Smallpox – morbilliform exanthem as initial cutaneous
manifestation
Cutis 71:319–321, 2003
South American Arenaviruses (Junin, Machupo, Sabia,
Guanarito)
Stevens–Johnson
syndrome
Stroke
Syphilis
Systemic lupus erythematosus
Tacaribe viruses – Argentinian, Bolivian and Venezuelan
hemorrhagic fevers – erythema of face, neck, and thorax with
petechiae
Lancet 338:1033–1036, 1991; JAMA 273:194–196,
1994
Togavirus – morbilliform, maculopapular–petechial (Sindbis)
Rook p.998, 1998, Sixth Edition; BJD 135:320–323, 1996; BJD
80:67–74, 1968; chickungunya Trans R Soc Trop Med Hyg
49:28–32, 1955; and O’nyong-nyong fever Trans R Soc Med
Hyg 55:361–373, 1961; bunyavirus fevers with joint pains; Ross
River virus – morbilliform eruption and
polyarthritis in Australia
and Fiji
Med J Aust 159:159–162, 1993; Barmah Forest virus –
similar to Ross River virus
Med J Aust 152:463–466, 1990
Tick typhus (Boutonneuse fever, Kenya tick typhus, African and
Indian tick typhus) (ixodid ticks) – small ulcer at site of tick bite
(tache noire) – black necrotic center with red halo; pink
morbilliform eruption of forearms, then generalizes, involving
face, palms, and soles; may be hemorrhagic; recovery
uneventful
JAAD 2:359–373, 1980
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