Mean number of lesions is 10–16
Skin lesions resolve in 3–5 days
Polyarticular arthritis, especially wrist, ankle, extensor tendon
sheaths, tenosynovitis
Monoarticular arthritis
Women during or after menses
Helicobacter cinaedi – cellulitis and monoarticular arthritis
Clin Inf Dis 20:564–570, 1995
Hepatitis A
JAAD 37:659–661, 1997
Hepatitis B
JAAD 8:539–548, 1983
Urticaria – ‘yellow hives’
Maculopapular eruption
Angioneurotic edema
Non-thrombocytopenic petechiae
Pruritus
Acute migratory or additive polyarthritis
Arthritis subsides with onset of jaundice
Hepatitis C associated mixed cryoglobulinema
AD
131:1185–1193, 1995; JAAD 34:219–223, 1996; livedo
reticularis
JAAD 37:659, 1997
HIV-1 acute infection – erythematous macules, morbilliform
eruptions on trunk and face, also palms and soles with
arthralgias
JAAD 28:167–173, 1993; AD 134:1279–1284, 1998
Human bite
Human herpesvirus 8 – relapsing inflammatory syndrome; fever,
lymphadenopathy, splenomegaly, edema, arthrosynovitis,
exanthema of hands, wrists, and elbows
NEJM 353:156–163,
2005
Infectious mononucleosis
Tyring p.148, 2002; Ghatan
p.171, 2002, Second Edition
Lassa fever (arenavirus) – morbilliform or petechial rash with
conjunctivitis
J Infect Dis 155:445–455, 1985
Leishmaniasis – dactylitis
Lemierre’s syndrome (human necrobacillosis) –
Fusobacterium
necrophorum; suppurative thrombophlebitis of tonsillar and
peritonsillar veins and internal jugular vein; oropharyngeal pain,
neck swelling, pulmonary symptoms, arthralgias
Clin Inf Dis
31:524–532, 2000
Leprosy – polyarthritis, dactylitis with erythema nodosum
leprosum
JAAD 51:416–426, 2004; AD 138:1607–1612, 2002;
Rook p.1227, 1998, Sixth Edition; leprous dactylitis Rook
p.1225, 1998, Sixth Edition
Lyme disease
Clin Inf Dis 31:533–542, 2000
Erythema migrans (erythema chronicum migrans)
Tick bite, red papule 3–32 days later, ECM
Thigh, groin, axilla
Bright red outer borders, flat, raised
Central clearing, indurated, vesicular, bullous, necrotic
Secondary lesions
Multiple annular, smaller, migrate less
Lack indurated centers
Recurrent skin lesions
Borrelial lymphocytoma (blue–red nodule of earlobe, scrotum,
breast)
Acrodermatitis chronica atrophicans
Arthritis
Late manifestation, from several weeks to years later
Intermittent, recurring in up to 40% of untreated patients
Lymphogranuloma venereum
JAAD 41:511–529, 1999
Melioidosis –
Burkholderia pseudomallei; septic arthritis,
abscesses, ulcers
Clin Inf Dis 31:981–986, 2000
Meningococcemia
Ped Derm 13:483–487, 1996; chronic BJD
153:669–671, 2005; Med J Aust 153:556–559, 1990
Moraxella osloensis – gonococcemia-like infection Cutis
21:657–659, 1978
Mumps – adult males
Murine typhus (
Rickettsia typhi) – arthralgia MMWR
52:1224–1226, 2003
Mycetoma
Mycobacterium abscessus – breast abscesses with
tenosynovitis; erythema over joints associated with
intramammary silicone breast implants with serum sickness-like
syndrome
JAAD 50:450–454, 2004
Mycobacterium haemophilum BJD 149:200–202, 2003; AD
138:229–230, 2002
Mycobacterium kansasii – swollen fingers JAAD
45:620–624, 2001
Mycobacterium marinum J Clin Microbiol 28:2570–2572, 1990
Mycobacterium tuberculosis – lichen scrofulosorum – dactylitis
Rook p.1200, 1998, Sixth Edition; yellow to red–brown
flat-topped papules, slightly scaly, surmounted with minute
pustule; trunk scrofulosorum
Ped Derm 17:373–376, 2000;
AD 124:1421–1426, 1988; Clin Exp Dermatol 1:391–394,
1976; lupus vulgaris; dactylitis; presenting as tophaceous gout
J Rheumatol 16:700–702, 1989
Mycotic aneurysm, femoral – arthritis and purpura
Br J Rheumatol 24:364–366, 1985
Nocardia asteroides
Ockelbo disease – arthritis, exanthem – due to Dindbis-virus
like agent
Lancet 1 (8275):795–796, 1982
Onchocerciasis
Cutis 65:293–297, 2000
Parvovirus B19 (erythema infectiosum, fifth disease)
JAAD 27:466, 1992; J Clin Inf Dis 21:1424–1430, 1995
Adults seldom have typical ‘slapped cheeks’
Papular–purpuric glove and socks syndrome
Macular, lacy or reticulate erythema on the extremities
Pruritus, sometimes severe, with or without rash in a patient
with acute onset arthritis
Sudden onset, symmetric polyarthritis, particularly of hands
Lupus-like presentation
J Rheumatol 19:169–171, 1992
Pasteurella multocida – periocular abscess and cellulitis;
tenosynovitis, septic arthritis
Am J Ophthalmol 128:514–515,
1999; JAAD 33:1019–1029, 1995
Pogost disease – alphavirus infection with rash and arthritis
J
Clin Lab Immunol 21:77–82, 1986
Rat bite fever (
Streptococcus moniliformis) – acral hemorrhagic
pustules
JAAD 38:330–332, 1998; septic arthritis MMWR
53:1198–1202, 2005; Clin Orthop 380:173–176, 2000
Erythematous macules, papules 2–3 days after symptoms:
Most marked on the extremities, particularly about joints;
Measles-like, involves palms and soles
Fever, chills, headache, myalgias, arthritis after rat bite
healed
Haverhill fever – erythema arthriticum epidemicum (‘Sodoku’) –
Spirillium minus
Relapsing fever (tick-borne relapsing fever) –
Ornithodoros
soft ticks transmitting
Borrelia hermsii, B.turicata, or B. parkeri;
1–2-cm rose-colored macules, papules, petechiae, purpura,
facial flushing; arthralgias, iritis, myalgia
JAAD 49:363–392,
2003; diffuse macular rash Tyring p.438, 2002
Rheumatic fever
JAAD 8:724–728, 1983
Abrupt onset polyarthritis, fever in adults
One-third of adults have no recollection of pharyngitis
Spreading erythematous rings (erythema marginatum)
Duration of rash – few hours; pattern changing hourly
Trunk and extremities
Carditis
Migratory arthritis
Dramatic response to salicylates
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