Rash with fever: Difference between revisions

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{{Search infobox}}
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{{CMG}}
==Overview==
Rash with Fever in adults can be caused by allergic reactions, Immune disorders, infections, etc.<ref name="pmid30981291">{{cite journal| author=Muzumdar S, Rothe MJ, Grant-Kels JM| title=The rash with maculopapules and fever in adults. | journal=Clin Dermatol | year= 2019 | volume= 37 | issue= 2 | pages= 109-118 | pmid=30981291 | doi=10.1016/j.clindermatol.2018.12.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30981291  }} </ref> <ref name="pmid23197907">{{cite journal| author=Tabak F, Murtezaoglu A, Tabak O, Ozaras R, Mete B, Kutlubay Z | display-authors=etal| title=Clinical features and etiology of adult patients with Fever and rash. | journal=Ann Dermatol | year= 2012 | volume= 24 | issue= 4 | pages= 420-5 | pmid=23197907 | doi=10.5021/ad.2012.24.4.420 | pmc=3505772 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23197907  }} </ref>. The infectious agents often trigger rash by mode of a toxin or an immunogenic reaction to the antigens. Infectious agents associated with fever with rash in adults can be viral or bacterial. Some examples of such organisms are the Rubeola virus, Staphylococcus aureus, Borrelia burgdorferi. Among allergic reactions, drugs reactions are the ones most commonly associated with Rash with Fever.
The clinical condition of the patient can range from mild flu-like symptoms in Lyme's disease to severe life-threatening situations such as Toxic shock syndrome caused by Staphylococcus aureus.   


==Causes==  
==Causes==  
===Life threatening causes===
* Toxic Shock syndrome caused by Staphcocci or Streptococci
* Staphylococcal Scalded Skin Syndrome causes by Staphylococcus aureus
* Toxic Epidermal Necrolysis-Steven Johnson syndrome (TEN-SJS)
* Acute meningococcemia by Neisseria Meningitidis
===Common causes===
* Measles/ Rubeola
* Drugs reactions
* Infectious Mononucleosis
* Adult-onset Stills disease
* West Nile Fever
* Rickettsial infections such as Lyme disease, Rocky Mountain spotted fever
* Systemic Lupus Erythematosus
===Less common causes===
* Typhoid fever
* Dengue fever
* Parvovirus B19
* Acute HIV infection
* Graft vs Host reaction
* Dermatomyositis
* Pyoderma gangrenosum
* Sweet Syndrome
===Causes by Organ system===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
|-
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" | Toxic Epidermal Necrolysis; Drug eruptions; Steven Johnson syndrome
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Genetic''' 
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | Lymphoma
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" | Various viral and bacterial agents eg Zika, Dengue, Roseola, Typhoid, Parvovirus B19, Meningococci, Staphylococci
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | Paraneoplastic syndrome
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" | SLE; Adult-Onset Still's disease; Dermatomyositis
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | No underlying causes
|-
|}


===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===


*[[Borrelia Burgdorferi]]
*[[Drug reaction]]s
*[[Drug reaction]]s
*[[Fifth disease]]
*[[Fifth disease]]
Line 23: Line 167:
*[[Varicella]]
*[[Varicella]]
*[[exanthem|Viral exanthem]]s
*[[exanthem|Viral exanthem]]s
==Diagnosis==
===History and Symptoms===
*Focused history is essential as fever w/ rash has many causes
*Determine toxicity
*A quick determination of RMSF and meningococcemia are important for immediate therapy
===Laboratory Findings===
*Labs include
:*Bacterial cultures from any wounds
:*Toxic patients - blood cultures
:*[[Meningococcemia]] (suspected) - Lumbar puncture
:*Antibody titers confirm [[RMSF]]
:*[[Skin biopsy]] can determine [[vasculitis]] and detect rickettsial organisms in [[endothelium]]
:*TSS - Wound cultures with growth of staph or strep
== Treatment ==
===Medical Therapy===
The most important thing is to evaluate the most dangerous diagnosis, then use "watch and wait" for less serious symptoms
====Pharmacotherapy====
=====Acute Pharmacotherapies=====
*RMSF - [[Doxycycline]]
*Meningococcal - [[Ceftriaxone]]


==References==
==References==

Revision as of 15:00, 17 December 2020
Resident
Survival
Guide

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Rash with Fever in adults can be caused by allergic reactions, Immune disorders, infections, etc.[1] [2]. The infectious agents often trigger rash by mode of a toxin or an immunogenic reaction to the antigens. Infectious agents associated with fever with rash in adults can be viral or bacterial. Some examples of such organisms are the Rubeola virus, Staphylococcus aureus, Borrelia burgdorferi. Among allergic reactions, drugs reactions are the ones most commonly associated with Rash with Fever. The clinical condition of the patient can range from mild flu-like symptoms in Lyme's disease to severe life-threatening situations such as Toxic shock syndrome caused by Staphylococcus aureus.

Causes

Life threatening causes

  • Toxic Shock syndrome caused by Staphcocci or Streptococci
  • Staphylococcal Scalded Skin Syndrome causes by Staphylococcus aureus
  • Toxic Epidermal Necrolysis-Steven Johnson syndrome (TEN-SJS)
  • Acute meningococcemia by Neisseria Meningitidis

Common causes

  • Measles/ Rubeola
  • Drugs reactions
  • Infectious Mononucleosis
  • Adult-onset Stills disease
  • West Nile Fever
  • Rickettsial infections such as Lyme disease, Rocky Mountain spotted fever
  • Systemic Lupus Erythematosus

Less common causes

  • Typhoid fever
  • Dengue fever
  • Parvovirus B19
  • Acute HIV infection
  • Graft vs Host reaction
  • Dermatomyositis
  • Pyoderma gangrenosum
  • Sweet Syndrome

Causes by Organ system

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Toxic Epidermal Necrolysis; Drug eruptions; Steven Johnson syndrome
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic Lymphoma
Iatrogenic No underlying causes
Infectious Disease Various viral and bacterial agents eg Zika, Dengue, Roseola, Typhoid, Parvovirus B19, Meningococci, Staphylococci
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Paraneoplastic syndrome
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy SLE; Adult-Onset Still's disease; Dermatomyositis
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes


Causes in Alphabetical Order[3][4]

References

  1. ↑ Muzumdar S, Rothe MJ, Grant-Kels JM (2019). "The rash with maculopapules and fever in adults". Clin Dermatol. 37 (2): 109–118. doi:10.1016/j.clindermatol.2018.12.004. PMID 30981291.
  2. ↑ Tabak F, Murtezaoglu A, Tabak O, Ozaras R, Mete B, Kutlubay Z; et al. (2012). "Clinical features and etiology of adult patients with Fever and rash". Ann Dermatol. 24 (4): 420–5. doi:10.5021/ad.2012.24.4.420. PMC 3505772. PMID 23197907.
  3. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  4. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X


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