Fever + Rash

Question 1

Rash Hx features?

Answer 1

• Morphology
• Duration
• Distribution
• Known allergies / exposures
• Current and previous Rx
• Existing systemic conditions
• Possible infectious exposure
• F/O/S/T
• Hx pharyngitis / strep throat
• URTI - viral

Question 2

Symptoms commonly associated with viral exanthema?

Answer 2

• Fever
• Malaise
• Pharyngitis
• Myalgia

Question 3

Ddx of erythematous rash with unwell child / systemic involvement?

Answer 3

• urticaria of hypersensitivity
• scarlet fever
• SSSS
• TSS
• early SJS
• Rheumatic fever
• Juvenile arthritis
• SLE
• sarcoidosis
• Lyme disease

Question 4

What are the possible features of rash due to hypersensitivity?

Answer 4

• generalised urticaria
• localised lesions e.g. if due to insect bites
• generalised swelling
• airway compromise
• hypotension
• tachycardia

Question 5

What is the duration of urticarial lesions due to hypersensitivity reactions?

Answer 5

24 - 48h. Eruption may last longer due to recurrent crops of lesions

Question 6

What is the description of scarlet fever rash?

Answer 6

• Sandpaper like generalised erythematous rash
• discrete skin coloured papules
• linear petechial streaks (Pastia lines) in skinfolds, esp of axillary, inguinal and antecubital fossae

Question 7

What are the Hx features of scarlet fever rash?

Answer 7

• usually follows pharyngitis or tonsillitis
• young children
• common between autumn and spring
• positive contact history (2-5d before symptoms)

Question 8

What PEx features may be associated with scarlet fever rash?

Answer 8

• tender cervical adenopathy
• pharyngeal erythema with exudates
• palatal petechiae
• red, swollen strawberry tongue

Question 9

What is the description of SSSS rash?

Answer 9

• Generalised erythematous rash with skin exfoliation
• Fragile bullae on skin surface
• +ve Nikolsky sign
  Superficial desquamation / exfoliation in 2-5d. Denuded and crusted underlying skin.

Question 10

What is a positive Nikolsky sign?

Answer 10

blister induced with lateral pressure

Question 11

Hx features of SSSS?

Answer 11

• Hx recent infection (skin / resp / GIT)
• usually 6 or younger
• Prodrome of fever, malaise, tender skin

Question 12

What is the rash of TSS?

Answer 12

Diffuse, erythematous rash on trunk, palms and soles. Cutaneous desquamation 1-2w after onset, starting on palms and soles.

Question 13

Clinical / Hx features of TSS?

Answer 13

• Hx recent surgery or super absorbent tampon use

- Systemic upset: fever, hTN, HA, confusion, malaise, pharyngitis, N/V/D.

Question 14

How is TSS diagnosed?

Answer 14

Clinically in presence of fever and hypotension

Question 15

What is the characteristic rash of SJS?

Answer 15

Targetoid lesions (annular erythematous rings with an outer erythematous zone and no central blistering sandwiching a zone of normal skin tone).

Question 16

What is the rash of Rheumatic fever?

Answer 16

Erythema marginatum: fleeting pink rash typically involving the trunk and proximal extremities.
-subcut nodules may be present: firm and painless

Question 17

What are the Hx features to elicit in Rheumatic fever rash prevention?

Answer 17

• recent sore throat
• prolonged fever
• migratory large joint tenderness
• CP
• dyspnoea
• Hx involuntary movements (Sydenham chorea)
• cardiac murmur or pericardial rub

Question 18

What is the characteristic rash of juvenile arthritis?

Answer 18

• transient, erythematous non pruritic rash

- favours trunk and site of pressure

Question 19

Hx feature of juvenile arthritis rash?

Answer 19

• Periodic fevers (often late afternoon, spiking in evening)
• joint pain
• myalgia

Question 20

Rash of SLE?

Answer 20

-Malar butterfly rash
also
- discoid
- photosensitive rash

Question 21

Hx features suggestive of SLE rash?

Answer 21

• Fever
• Fatigue
• Recurrent infeciton
• Arthralgias
• Malaise
• CP

Question 22

PEx features suggestive of SLE?

Answer 22

• Arthritis
• Serositis
• HTN
• Oedema
• Hepatomegaly
• Splenomegaly
• Lymphadenopathy