1. FEVER AND
RASH
YASSIN ALSALEH

2. introduction
Common problem.
vary from simple one to an early sign of
a life-threatening condition .
Mostly due to infection .

3. definitions
Macule — Nonpalpable, circumscribed flat ,< 1 cm
Papule — Palpable ,solid, elevated, < 1 cm
Maculopapular -erythematous rash made up of both
macular and papular lesions.
Purpura — Papular or macular nonblanching lesions
Nodule — Deep-seated, roundish < 1.5 cm
Plaque — A palpable elevated > 1
Vesicle —elevated ,contains fluid ,<1 cm
Bulla —vesicle > 1 cm
Pustule —vesicle + pus

4. history
Characteristics of the lesions
Distribution and progression of the rash
Timing of the onset in relation to fever
Change in morphology, such as papules
to vesicles or petechiae

5. History (important clues)
Age of the patient
Season of the year
Travel history
Exposures including to insects and ill
contacts
Medications
Immunizations and history of childhood
illnesses

6. Physical examination
Vital signs
General appearance
lymph nodes.
mucous membranes, conjunctivae,
ABDOMIN: Liver and spleen size
CNS: Meningeal signs
CVS: murmur

7. DDx

8. Measles (rubeola)

9. Measles (rubeola)
maculopapular rash beginning in the head
and neck area and spreading centrifugally
to the trunk and extremities;
fever, cough, coryza, and conjunctivitis
high-dose vitamin A does
seem to decrease the morbidity and mortality

10. Important sign: Koplik’s spots

11. Chickenpox

12. Chickenpox
is characterized by classic vesicular
lesions on an erythematous base that
appear in crops .
present in different stages from papules
through vesicles to crusting .
Don’t underestimate few vesicles in era of
vaccination

13. Rubella

14. Rubella
not sick.
prominent postauricular, posterior
cervical, and/or suboccipital adenopathy.
Treatment : supportive .
3 days measles

15. Rubella
Clinical sign:
Forchheimer’s sign.
Petechiae on the hard
palate

16. Erythema infectiosum (fifth
disease)

17. Erythema infectiosum (fifth
disease)
Erythema infectiosum (fifth disease) is due
to human parvovirus B19.
rash with a "slapped cheeks" appearance
Treatment: supportive .
Pregnant and those with chronic hemolytic
anemia at high risk

18. Roseola infantum ( exanthem
subitum)

19. Roseola infantum ( exanthem
subitum)
a human herpesvirus 6 or 7 infection.
primarily seen in infants.
is characterized by high fever for three to
four days followed by generalized
maculopapular rash that spreads from the
trunk to the extremities .
Assosiated with febrile convulsion
Fever then rash not at same time

20. Scarlet fever

21. Scarlet fever
Caused by group A streptococcus (GAS)
infection.
manifested by a coarse, sandpaper-like,
erythematous, blanching rash.
This is accompanied by a strawberry
tongue.
Treatment: antibiotics
you will feel it

22. Acute rheumatic fever (ARF)

23. Acute rheumatic fever
The classic dermatologic manifestations of
ARF are erythema marginatum
transient macular lesions with central
clearing found on the extensor surfaces of
the proximal extremities and trunk.
Less than 5 %

24. Kawasaki

25. Kawasaki
a disease of unknown etiology.
is usually seen in children less than 5 years of
age.
In addition to fever lasting >5 days,
bilateral conjunctival injection.
injected or fissured lips, injected pharynx or
'strawberry tongue' .
erythema of the palms or soles, edema of the
hands or feet or generalized or periungual
desquamation.
Don’t forget
Rash.
cervical lymphadenopathy . atypical

26. MYCOPLASMA

27. MYCOPLASMA
Mild maculopapular rash.
Eythema multiforme.
Stevens –johnson syndrome.

28. Infectious mononucleosis

29. Infectious mononucleosis
present with fever, sweats, anorexia,
nausea, chills, sore throat, posterior
cervical lymphadenopathy, splenomegaly,
and a maculopapular rash.
especially after the administration of
ampicilin .
Gentle abdominal exam

30. Bacterial endocarditis

31. Bactrial endocarditis
mucocutaneous lesions include petechiae,
splinter hemorrhages, Janeway lesions,
and Osler's nodes
Staph aurues is most common organisim

32. Meningococcal infection

33. Meningococcal infection
In addition to fever, headache, and
nausea, rash
Early lesions may be macular, but rapidly
increasing numbers of petechial or
purpuric lesions can develop on the distal
extremities and trunk, usually sparing the
palms and soles
ANTIBOTICS, ANTIBOTICS, ANTIBOTICS,

34. THANK YOU