Internal Medicine/Fever and Rash

Introduction

Fever and rash are common symptoms of various medical conditions. The presence of both fever and rash can be indicative of a wide range of diseases, including viral infections, drug reactions, autoimmune disorders, and more. Understanding the characteristics of the rash, along with other accompanying symptoms, is crucial for accurate diagnosis and appropriate medical management.

Viral Infections

Many viral infections are associated with fever and rash. These infections often have distinct rash patterns and other symptoms:

Measles (Rubeola):

Rash Description: Centrally distributed maculopapular eruption.
Additional Symptoms: Cough, runny nose, conjunctivitis, fever.
Causative Agent: Measles virus.

Rubella (German Measles):

Rash Description: Pink macules and papules, initially on the face.
Additional Symptoms: Lymphadenopathy, fever.
Causative Agent: Rubella virus.

Erythema Infectiosum (Fifth Disease):

Rash Description: Bright red cheeks followed by lacy rash.
Additional Symptoms: Mild fever, malaise.
Causative Agent: Parvovirus B19.

Roseola (Exanthem Subitum):

Rash Description: Pink macules and papules that fade quickly.
Additional Symptoms: High fever, irritability.
Causative Agent: Human herpesvirus 6 or 7.

Drug-Induced Eruptions:

Rash Description: Eruptions with various appearances.
Additional Symptoms: Depends on the drug and individual.
Causative Agent: Various drugs.

Other Infectious Causes

Apart from viral infections, various other infectious diseases can present with fever and rash:

Rickettsial Illnesses:

Rash Description: Centrally distributed maculopapular eruptions.
Additional Symptoms: Fever, headache, body aches.
Causative Agent: Various species of rickettsia.

Lyme Disease:

Rash Description: Single or multiple annular lesions.
Additional Symptoms: Fatigue, joint pain, fever.
Causative Agent: Borrelia burgdorferi.

Systemic Lupus Erythematosus:

Rash Description: Butterfly-shaped erythematous rash on the cheeks.
Additional Symptoms: Joint pain, fatigue, organ involvement.
Causative Agent: Autoimmune response.

Dengue Fever:

Rash Description: Maculopapular eruption.
Additional Symptoms: High fever, severe joint and muscle pain.
Causative Agent: Dengue virus.

Zika Virus Infection:

Rash Description: Pruritic maculopapular rash.
Additional Symptoms: Conjunctival injection, fever.
Causative Agent: Zika virus.

Peripheral Eruptions

Certain diseases manifest with rash primarily on peripheral areas:

Rocky Mountain Spotted Fever:

Rash Description: Petechial eruption that starts on the wrists.
Additional Symptoms: High fever, headache, muscle pain.
Causative Agent: Rickettsia rickettsii.

Hand-Foot-and-Mouth Disease:

Rash Description: Tender vesicles on hands, feet, and mouth.
Additional Symptoms: Sore throat, fever, mouth sores.
Causative Agent: Enteroviruses (e.g., Coxsackievirus A16).

Erythema Multiforme:

Rash Description: Target lesions on extremities and face.
Additional Symptoms: Fever, malaise, mucosal involvement.
Causative Agent: Immune response to infections or drugs.

Pernio (Chilblains):

Rash Description: Tender violaceous lesions on acral areas.
Additional Symptoms: Itching, pain, cold exposure.
Causative Agent: Cold exposure.

Confluent Desquamative Erythemas

Some eruptions consist of diffuse erythema followed by desquamation:

Scarlet Fever:

Rash Description: Facial flush, "strawberry" tongue, petechiae.
Additional Symptoms: Sore throat, fever, enlarged tonsils.
Causative Agent: Streptococcus pyogenes (Group A Strep).

Varicella (Chickenpox):

Rash Description: Pruritic lesions in various stages of development.
Additional Symptoms: Fever, fatigue, itching.
Causative Agent: Varicella-zoster virus.

Herpes Simplex Virus Infection:

Rash Description: Grouped vesicles on an erythematous base.
Additional Symptoms: Tingling or burning sensation, fever.
Causative Agent: Herpes simplex virus.

Echovirus 9 Infection:

Rash Description: Petechial eruption.
Additional Symptoms: High fever, headache, muscle pain.
Causative Agent: Echovirus 9.

Purpuric and Ulcerative Eruptions

Certain conditions present with purpura or ulcers:

Purpura Fulminans:

Rash Description: Large ecchymotic areas of purpura.
Additional Symptoms: Severe underlying coagulation disorder.
Causative Agent: Infectious or noninfectious causes.

Viral Hemorrhagic Fever:

Rash Description: Petechial rash.
Additional Symptoms: Hemorrhagic symptoms, organ dysfunction.
Causative Agent: Various hemorrhagic fever viruses.

Thrombotic Thrombocytopenic Purpura (TTP):

Rash Description: Petechiae and purpura.
Additional Symptoms: Neurological symptoms, renal dysfunction.
Causative Agent: TTP-related factors or hereditary causes.

Cutaneous Small-Vessel Vasculitis:

Rash Description: Palpable purpura.
Additional Symptoms: Joint pain, abdominal pain, kidney issues.
Causative Agent: Various causes.

Eruptions with Ulcers or Eschars

In some cases, the presence of ulcers or eschars in the rash can provide important diagnostic clues:

Scrub Typhus:

Rash Description: Ulcer or eschar.
Additional Symptoms: Fever, headache, muscle pain.
Causative Agent: Orientia tsutsugamushi (bacteria).

Anthrax:

Rash Description: Ulcer or eschar.
Additional Symptoms: High fever, fatigue, respiratory symptoms.
Causative Agent: Bacillus anthracis (bacteria).

Urticaria-Like Eruptions

Some individuals with fever may experience urticaria-like eruptions, which typically involve skin hypersensitivity reactions:

Classic Urticaria (Hives):

Rash Description: Erythematous, raised wheals.
Additional Symptoms: Itching, stinging.
Causative Agent: Hypersensitivity reactions.

Urticarial Vasculitis:

Rash Description: Palpable purpura lasting longer than 24 hours.
Additional Symptoms: Joint pain, abdominal discomfort, fever.
Causative Agent: Immune complex deposition.

Nodular Eruptions

In immunocompromised individuals, nodular lesions may indicate disseminated infections or other underlying conditions:

Disseminated Candidiasis:

Rash Description: Eruptive nodules.
Additional Symptoms: Fever, myalgias.
Causative Agent: Candida species, particularly Candida tropicalis.

Disseminated Cryptococcosis:

Rash Description: Nodules resembling molluscum contagiosum.
Additional Symptoms: Fever, respiratory symptoms.
Causative Agent: Cryptococcus neoformans.

Sweet Syndrome:

Rash Description: Nodules or plaques with edema.
Additional Symptoms: Fever, joint pain, fatigue.
Causative Agent: Associated with infections, inflammatory conditions, or malignancy.

Diseases with Ulcers or Eschars

The presence of ulcers or eschars in the rash can be indicative of specific diseases:

Scrub Typhus:

Rash Description: Ulcer or eschar.
Additional Symptoms: Fever, headache, muscle pain.
Causative Agent: Orientia tsutsugamushi (bacteria).

Anthrax:

Rash Description: Ulcer or eschar.
Additional Symptoms: High fever, fatigue, respiratory symptoms.
Causative Agent: Bacillus anthracis (bacteria).

Conclusion

Fever and rash can be symptoms of various medical conditions, ranging from viral infections to drug reactions, autoimmune disorders, and more. Accurate diagnosis and appropriate medical management depend on recognizing the specific characteristics of the rash, along with other accompanying symptoms. If you experience fever and rash, it is essential to seek medical attention for proper evaluation and treatment.