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Symptom: Rash and Itching
Rash with a Fever
MAJ Daniel Schissel, MC, USAThe sudden appearance of a cutaneous eruption and a fever is frightening and an often intimidating clinical
challenge. Rarely does one have to rely solely on their morphologic assessment as when confronted by an
acutely ill patient with a fever and a rash. If a diagnosis is not established quickly in certain patients (e.g.,
septicemia ), life-saving treatments may be delayed unnecessarily. Furthermore, rapid diagnosis and isolation
of patients with contagious disease prevents spread to other persons and preserves the fighting force.
Contagious cutaneous diseases presenting with fever and a rash include viral infections (e.g., adenovirus,
echovirus, herpes simplex, measles, rubella, varicella/chicken pox) and bacterial infections (e.g., meningococ-
cal, staphylococcal, streptococcal, and secondary syphilis.) As mentioned in the Dermatology Introduction
(see Skin chapter), the morphologic diagnosis of cutaneous eruptions is a discipline based on detailed
observation, with precise identification of the primary and secondary skin lesions being paramount.
The differential diagnosis of an acutely ill febrile patient with a rash may be broken down into three main
categories according the primary lesion(s) observed. Refer to the specific illness in the Infectious Disease or
Dermatology chapters for more diagnostic and treatment information.
Disease Macules Vesicles, Purpuric Macules,
or Bullae, or Papules, or
Papules Pustules Vesicles
BACTERIAL:
Cat-Scratch X X
Gonococcemia X
Meningococcemia X X X
Pseudomonas aeruginosa X X
Staphlococcal
Erysipelas X X X
Scalded Skin Syndrome X X
Toxic Shock Syndrome X X
Streptococcal (Scarlet fever) X X
Tularemia X X
RICKETTSIAL:
Boutonneuse Fever X
Richettsialpox X X
Rocky Mountain Spotted fever X X X
Trench Fever X
Typhoid Fever X
Typhus, Louse-borne/epidemic X X
Typhus, Murine/endemic X
Typhus, Scrub X X
VIRAL:
Adenoviral infections X
AIDS / HIV X X
Enterovirus infections
Echo, Coxsackie X X X