Centrally Distributed Maculopapular Eruptions |
Acute meningococcemiaa | — | — | — | — | 52 |
Drug reaction with eosinophilia and systemic symptoms (DRESS) (also termed drug-induced hypersensitivity syndrome; DIHS)b | — | — | — | — | |
Rubeola (measles, first disease) | Paramyxovirus | Discrete lesions that become confluent as rash spreads from hairline downward, usually sparing palms and soles; lasts ≥3 days; Koplik’s spots | Nonimmune individuals | Cough, conjunctivitis, coryza, severe prostration | 102 |
Rubella (German measles, third disease) | Togavirus | Spreads from hairline downward, clearing as it spreads; Forschheimer spots | Nonimmune individuals | Adenopathy, arthritis | 103 |
Erythema infectiosum (fifth disease) | Human parvovirus B19 | Bright-red “slapped-cheeks” appearance followed by lacy reticular rash that waxes and wanes over 3 weeks; rarely, papular-purpuric “gloves-and-socks” syndrome on hands and feet | Most common among children 3–12 years old; occurs in winter and spring | Mild fever; arthritis in adults; rash following resolution of fever | 93 |
Exanthem subitum (roseola, sixth disease) | Human herpesvirus 6 | Diffuse maculopapular eruption over trunk and neck; resolves within 2 days | Usually affects children <3 years old | Rash following resolution of fever; similar to Boston exanthem (echovirus 16); febrile seizures may occur | 91 |
Primary HIV infection | HIV | Nonspecific diffuse macules and papules; less commonly, urticarial or vesicular oral or genital ulcers | Individuals recently infected with HIV | Pharyngitis, adenopathy, arthralgias | 97 |
Infectious mononucleosis | Epstein-Barr virus | Diffuse maculopapular eruption (5% of cases; 90% if ampicillin is given); urticaria, petechiae in some cases; periorbital edema (50%); palatal petechiae (25%) | Adolescents, young adults | Hepatosplenomegaly, pharyngitis, cervical lymphadenopathy, atypical lymphocytosis, heterophile antibody | 90 |
Other viral exanthems | Echoviruses 2, 4, 9, 11, 16, 19, 25; coxsackieviruses A9, B1, B5; etc. | Wide range of skin findings that may mimic rubella or measles | Affect children more commonly than adults | Nonspecific viral syndromes | 101 |
Exanthematous drug-induced eruption | Drugs (antibiotics, anticonvulsants, diuretics, etc.) | Intensely pruritic, bright-red macules and papules, symmetric on trunk and extremities; may become confluent | Occurs 2–3 days after exposure in previously sensitized individuals; otherwise, after 2–3 weeks (but can occur anytime, even shortly after drug is discontinued) | Variable findings: fever and eosinophilia | |
Epidemic typhus | Rickettsia prowazekii | Maculopapular eruption appearing in axillae, spreading to trunk and later to extremities; usually spares face, palms, soles; evolves from blanchable macules to confluent eruption with petechiae; rash evanescent in recrudescent typhus (Brill-Zinsser disease) | Exposure to body lice; occurrence of recrudescent typhus as relapse after 30–50 years | Headache, myalgias; mortality rates 10–40% if untreated; milder clinical presentation in recrudescent form | 83 |
Endemic (murine) typhus | Rickettsia typhi | Maculopapular eruption, usually sparing palms, soles | Exposure to rat or cat fleas | Headache, myalgias | 83 |
Scrub typhus | Orientia tsutsugamushi | Diffuse macular rash starting on trunk; eschar at site of mite bite | Endemic in South Pacific, Australia, Asia; transmitted by mites | Headache, myalgias, regional adenopathy; mortality rates up to 30% if untreated | 83 |
Rickettsial spotted fevers | Rickettsia conorii (boutonneuse fever), Rickettsia australis (North Queensland tick typhus), Rickettsia sibirica (Siberian tick typhus), and others | Eschar common at bite site; maculopapular (rarely, vesicular and petechial) eruption on proximal extremities, spreading to trunk and face | Exposure to ticks; R. conorii in Mediterranean region, India, Africa; R. australis in Australia; R. sibirica in Siberia, Mongolia | Headache, myalgias, regional adenopathy | 83 |
Human monocytotropic ehrlichiosisc | Ehrlichia chaffeensis | Maculopapular eruption (40% of cases), involves trunk and extremities; may be petechial | Tick-borne; most common in U.S. Southeast, southern Midwest, and mid-Atlantic regions | Headache, myalgias, leukopenia | 83 |
Leptospirosis | Leptospira interrogans | Maculopapular eruption; conjunctivitis; scleral hemorrhage in some cases | Exposure to water contaminated with animal urine | Myalgias; aseptic meningitis; fulminant form: icterohemorrhagic fever (Weil’s disease) | 80 |
Lyme disease | Borrelia burgdorferi (sole cause in U.S.), Borrelia afzelii, Borrelia garinii | Papule expanding to erythematous annular lesion with central clearing (erythema migrans; average diameter, 15 cm), sometimes with concentric rings, sometimes with indurated or vesicular center; multiple secondary erythema migrans lesions in some cases | Bite of Ixodes tick vector | Headache, myalgias, chills, photophobia occurring acutely; CNS disease, myocardial disease, arthritis weeks to months later in some cases | 82 |
Southern tick-associated rash illness (STARI, Master’s disease) | Unknown (possibly Borrelia lonestari or other Borrelia spirochetes) | Similar to erythema migrans of Lyme disease with several differences, including: multiple secondary lesions less likely; lesions tending to be smaller (average diameter, ~8 cm); central clearing more likely | Bite of tick vector Amblyomma americanum (Lone Star tick); often found in regions where Lyme disease is uncommon, including southern United States | Compared with Lyme disease: fewer constitutional symptoms, tick bite more likely to be recalled; other Lyme disease sequelae lacking | 82 |
Typhoid fever | Salmonella typhi | Transient, blanchable erythematous macules and papules, 2–4 mm, usually on trunk (rose spots) | Ingestion of contaminated food or water (rare in U.S.) | Variable abdominal pain and diarrhea; headache, myalgias, hepatosplenomegaly | 62 |
Dengue feverd | Dengue virus (4 serotypes; flaviviruses) | Rash in 50% of cases; initially diffuse flushing; midway through illness, onset of maculopapular rash, which begins on trunk and spreads centrifugally to extremities and face; pruritus, hyperesthesia in some cases; after defervescence, petechiae on extremities in some cases | Occurs in tropics and subtropics; transmitted by mosquito | Headache, musculoskeletal pain (“breakbone fever”); leukopenia; occasionally biphasic (“saddleback”) fever | 106 |
Rat-bite fever (sodoku) | Spirillum minus | Eschar at bite site; then blotchy violaceous or red-brown rash involving trunk and extremities | Rat bite; primarily found in Asia; rare in U.S. | Regional adenopathy; recurrent fevers if untreated | 40 |
Relapsing fever | Borrelia species | Central rash at end of febrile episode; petechiae in some cases | Exposure to ticks or body lice | Recurrent fever, headache, myalgias, hepatosplenomegaly | 81 |
Erythema marginatum (rheumatic fever) | Group A Streptococcus | Erythematous annular papules and plaques occurring as polycyclic lesions in waves over trunk, proximal extremities; evolving and resolving within hours | Patients with rheumatic fever | Pharyngitis preceding polyarthritis, carditis, subcutaneous nodules, chorea | 46 |
Systemic lupus erythematosus (SLE) | Autoimmune disease | Macular and papular erythema, often in sun-exposed areas; discoid lupus lesions (local atrophy, scale, pigmentary changes); periungual telangiectasis; malar rash; vasculitis sometimes causing urticaria, palpable purpura; oral erosions in some cases | Most common in young to middle-aged women; flares precipitated by sun exposure | Arthritis; cardiac, pulmonary, renal, hematologic, and vasculitic disease | |
Still’s disease | Autoimmune disease | Transient 2- to 5-mm erythematous papules appearing at height of fever on trunk, proximal extremities; lesions evanescent | Children and young adults | High spiking fever, polyarthritis, splenomegaly; erythrocyte sedimentation rate, >100 mm/h | |
African trypanosomiasis | Trypanosoma brucei rhodesiense/gambiense | Blotchy or annular erythematous macular and papular rash (trypanid), primarily on trunk; pruritus; chancre at site of tsetse fly bite may precede rash by several weeks | Tsetse fly bite in eastern (T. brucei rhodesiense) or western (T. brucei gambiense) Africa | Hemolymphatic disease followed by meningoencephalitis; Winterbottom’s sign (posterior cervical lymphadenopathy) (T. brucei gambiense) | 127 |
Arcanobacterial pharyngitis | Arcanobacterium (Corynebacterium) haemolyticum | Diffuse, erythematous, maculopapular eruption involving trunk and proximal extremities; may desquamate | Children and young adults | Exudative pharyngitis, lymphadenopathy | 47 |
West Nile fever | West Nile virus | Maculopapular eruption involving the trunk, extremities, and head or neck; rash in 20–50% of cases | Mosquito bite; rarely, blood transfusion or transplanted organ | Headache, weakness, malaise, myalgias, neuroinvasive disease (encephalitis, meningitis, flaccid paralysis) | 106 |
Peripheral Eruptions |
Chronic meningococcemia, disseminated gonococcal infection,a human parvovirus B19 infectione | — | — | — | — | 52, 53, 93 |
Rocky Mountain spotted fever | Rickettsia rickettsii | Rash beginning on wrists and ankles and spreading centripetally; appears on palms and soles later in disease; lesion evolution from blanchable macules to petechiae | Tick vector; widespread but more common in southeastern and southwest-central U.S. | Headache, myalgias, abdominal pain; mortality rates up to 40% if untreated | 83 |
Secondary syphilis | Treponema pallidum | Coincident primary chancre in 10% of cases; copper-colored, scaly papular eruption, diffuse but prominent on palms and soles; rash never vesicular in adults; condyloma latum, mucous patches, and alopecia in some cases | Sexually transmitted | Fever, constitutional symptoms | 78 |
Chikungunya fever | Chikungunya virus | Maculopapular eruption; prominent on upper extremities and face, but can also occur on trunk and lower extremities | Aedes aegypti and A. albopictus mosquito bites; primarily in Africa and Indian Ocean region | Severe polyarticular, migratory arthralgias, especially involving small joints (e.g., hands, wrists, ankles) | 106 |
Hand-foot-and-mouth disease | Coxsackievirus A16 most common cause | Tender vesicles, erosions in mouth; 0.25-cm papules on hands and feet with rim of erythema evolving into tender vesicles | Summer and fall; primarily children <10 years old; multiple family members | Transient fever | 101 |
Erythema multiforme (EM) | Infection, drugs, idiopathic causes | Target lesions (central erythema surrounded by area of clearing and another rim of erythema) up to 2 cm; symmetric on knees, elbows, palms, soles; spreads centripetally; papular, sometimes vesicular; when extensive and involving mucous membranes, termed EM major | Herpes simplex virus or Mycoplasma pneumoniae infection; drug intake (i.e., sulfa, phenytoin, penicillin) | 50% of patients <20 years old; fever more common in most severe form, EM major, which can be confused with Stevens-Johnson syndrome (but EM major lacks prominent skin sloughing) | —f |
Rat-bite fever (Haverhill fever) | Streptobacillus moniliformis | Maculopapular eruption over palms, soles, and extremities; tends to be more severe at joints; eruption sometimes becoming generalized; may be purpuric; may desquamate | Rat bite, ingestion of contaminated food | Myalgias; arthritis (50%); fever recurrence in some cases | 40 |
Bacterial endocarditis | Streptococcus, Staphylococcus, etc. | Subacute course: Osler’s nodes (tender pink nodules on finger or toe pads); petechiae on skin and mucosa; splinter hemorrhages. Acute course (e.g., Staphylococcus aureus): Janeway lesions (painless erythematous or hemorrhagic macules, usually on palms and soles) | Abnormal heart valve (e.g., viridans group streptococci), intravenous drug use | New or changing heart murmur | 24 |
Confluent Desquamative Erythemas |
Scarlet fever (second disease) | Group A Streptococcus (pyrogenic exotoxins A, B, C) | Diffuse blanchable erythema beginning on face and spreading to trunk and extremities; circumoral pallor; “sandpaper” texture to skin; accentuation of linear erythema in skin folds (Pastia’s lines); enanthem of white evolving into red “strawberry” tongue; desquamation in second week | Most common among children 2–10 years old; usually follows group A streptococcal pharyngitis | Fever, pharyngitis, headache | 44 |
Kawasaki disease | Idiopathic causes | Rash similar to scarlet fever (scarlatiniform) or EM; fissuring of lips, strawberry tongue; conjunctivitis; edema of hands, feet; desquamation later in disease | Children <8 years old | Cervical adenopathy, pharyngitis, coronary artery vasculitis | |
Streptococcal toxic shock syndrome | Group A Streptococcus (associated with pyrogenic exotoxin A and/or B or certain M types) | When present, rash often scarlatiniform | May occur in setting of severe group A streptococcal infections (e.g., necrotizing fasciitis, bacteremia, pneumonia) | Multiorgan failure, hypotension; mortality rate 30% | 44 |
Staphylococcal toxic shock syndrome | S. aureus (toxic shock syndrome toxin 1, enterotoxins B and others) | Diffuse erythema involving palms; pronounced erythema of mucosal surfaces; conjunctivitis; desquamation 7–10 days into illness | Colonization with toxin-producing S. aureus | Fever >39°C (>102°F), hypotension, multiorgan dysfunction | 43 |
Staphylococcal scalded-skin syndrome | S. aureus, phage group II | Diffuse tender erythema, often with bullae and desquamation; Nikolsky’s sign | Colonization with toxin-producing S. aureus; occurs in children <10 years old (termed Ritter’s disease in neonates) or adults with renal dysfunction | Irritability; nasal or conjunctival secretions | 43 |
Exfoliative erythroderma syndrome | Underlying psoriasis, eczema, drug eruption, mycosis fungoides | Diffuse erythema (often scaling) interspersed with lesions of underlying condition | Usually occurs in adults over age 50; more common among men | Fever, chills (i.e., difficulty with thermoregulation); lymphadenopathy | |
DRESS (DIHS) | Aromatic anticonvulsants; other drugs, including sulfonamides, minocycline | Maculopapular eruption (mimicking exanthematous drug rash), sometimes progressing to exfoliative erythroderma; profound edema, especially facial; pustules may occur | Individuals genetically unable to detoxify arene oxides (anticonvulsants), patients with slow N-acetylating capacity (sulfonamides) | Lymphadenopathy, multiorgan failure (especially hepatic), eosinophilia, atypical lymphocytes; mimics sepsis | |
Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) | Drugs (80% of cases; often allopurinol, anticonvulsants, antibiotics), infection, idiopathic | Erythematous and purpuric macules, sometimes targetoid, or diffuse erythema progressing to bullae, with sloughing and necrosis of entire epidermis; Nikolsky’s sign; involves mucosal surfaces; TEN (>30% epidermal necrosis) is maximal form; SJS involves <10% of epidermis; SJS/TEN overlap involves 10–30% of epidermis | Uncommon among children; more common among patients with HIV infection, SLE, certain HLA types, or slow acetylators | Dehydration, sepsis sometimes resulting from lack of normal skin integrity; mortality rates up to 30% | |
Vesiculobullous or Pustular Eruptions |
Hand-foot-and-mouth syndromeg; staphylococcal scalded-skin syndrome; TENb; DRESSb | — | — | — | — | —f |
Varicella (chickenpox) | VZV | Macules (2–3 mm) evolving into papules, then vesicles (sometimes umbilicated), on an erythematous base (“dewdrops on a rose petal”); pustules then forming and crusting; lesions appearing in crops; may involve scalp, mouth; intensely pruritic | Usually affects children; 10% of adults susceptible; most common in late winter and spring; incidence down by 90% in U.S. as a result of varicella vaccination | Malaise; generally mild disease in healthy children; more severe disease with complications in adults and immunocompromised children | 89 |
Pseudomonas “hot-tub” folliculitis | Pseudomonas aeruginosa | Pruritic erythematous follicular, papular, vesicular, or pustular lesions that may involve axillae, buttocks, abdomen, and especially areas occluded by bathing suits; can manifest as tender isolated nodules on palmar or plantar surfaces (the latter designated “Pseudomonas hot-foot syndrome”) | Bathers in hot tubs or swimming pools; occurs in outbreaks | Earache, sore eyes and/or throat; fever may be absent; generally self-limited | 61 |
Variola (smallpox) | Variola major virus | Red macules on tongue and palate evolving to papules and vesicles; skin macules evolving to papules, then vesicles, then pustules over 1 week, with subsequent lesion crusting; lesions initially appearing on face and spreading centrifugally from trunk to extremities; differs from varicella in that (1) skin lesions in any given area are at same stage of development and (2) there is a prominent distribution of lesions on face and extremities (including palms, soles) | Nonimmune individuals exposed to smallpox | Prodrome of fever, headache, backache, myalgias; vomiting in 50% of cases | 10 |
Primary herpes simplex virus (HSV) infection | HSV | Erythema rapidly followed by hallmark painful grouped vesicles that may evolve into pustules that ulcerate, especially on mucosal surfaces; lesions at site of inoculation: commonly gingivostomatitis for HSV-1 and genital lesions for HSV-2; recurrent disease milder (e.g., herpes labialis does not involve oral mucosa) | Primary infection most common among children and young adults for HSV-1 and among sexually active young adults for HSV-2; no fever in recurrent infection | Regional lymphadenopathy | 88 |
Disseminated herpesvirus infection | Varicella-zoster virus (VZV) or HSV | Generalized vesicles that can evolve to pustules and ulcerations; individual lesions similar for VZV and HSV. Zoster cutaneous dissemination: >25 lesions extending outside involved dermatome. HSV: extensive, progressive mucocutaneous lesions that may occur in absence of dissemination, sometimes disseminate in eczematous skin (eczema herpeticum); HSV visceral dissemination may occur with only localized mucocutaneous disease; in disseminated neonatal disease, skin lesions diagnostically helpful when present, but rash absent in a substantial minority of cases | Patients with immunosuppression, eczema; neonates | Visceral organ involvement (e.g., liver, lungs) in some cases; neonatal disease particularly severe | 36, 88, 89 |
Rickettsialpox | Rickettsia akari | Eschar found at site of mite bite; generalized rash involving face, trunk, extremities; may involve palms and soles; <100 papules and plaques (2–10 mm); tops of lesions developing vesicles that may evolve into pustules | Seen in urban settings; transmitted by mouse mites | Headache, myalgias, regional adenopathy; mild disease | 83 |
Acute generalized eruptive pustulosis | Drugs (mostly anticonvulsants or antimicrobials); also viral | Tiny sterile nonfollicular pustules on erythematous, edematous skin; begins on face and in body folds, then becomes generalized | Appears 2–21 days after start of drug therapy, depending on whether patient has been sensitized | Acute fever, pruritus, leukocytosis | |
Disseminated Vibrio vulnificus infection | V. vulnificus | Erythematous lesions evolving into hemorrhagic bullae and then into necrotic ulcers | Patients with cirrhosis, diabetes, renal failure; exposure by ingestion of contaminated saltwater, seafood | Hypotension; mortality rate 50% | 65 |
Ecthyma gangrenosum | P. aeruginosa, other gram-negative rods, fungi | Indurated plaque evolving into hemorrhagic bulla or pustule that sloughs, resulting in eschar formation; erythematous halo; most common in axillary, groin, perianal regions | Usually affects neutropenic patients; occurs in up to 28% of individuals with Pseudomonas bacteremia | Clinical signs of sepsis | 61 |
Urticaria-Like Eruptions |
Urticarial vasculitis | Serum sickness, often due to infection (including hepatitis B viral, enteroviral, parasitic), drugs; connective tissue disease | Erythematous, edematous “urticaria-like” plaques, pruritic or burning; unlike urticaria: typical lesion duration >24 h (up to 5 days) and lack of complete lesion blanching with compression due to hemorrhage | Patients with serum sickness (including hepatitis B), connective tissue disease | Fever variable; arthralgias/arthritis | |
Nodular Eruptions |
Disseminated infection | Fungal infections (e.g., candidiasis, histoplasmosis, cryptococcosis, sporotrichosis, coccidioidomycosis); mycobacteria | Subcutaneous nodules (up to 3 cm); fluctuance, draining common with mycobacteria; necrotic nodules (extremities, periorbital or nasal regions) common with Aspergillus, Mucor | Immunocompromised hosts (i.e., bone marrow transplant recipients, patients undergoing chemotherapy, HIV-infected patients, alcoholics) | Features vary with organism | —f |
Erythema nodosum (septal panniculitis) | Infections (e.g., streptococcal, fungal, mycobacterial, yersinial); drugs (e.g., sulfas, penicillins, oral contraceptives); sarcoidosis; idiopathic causes | Large, violaceous, nonulcerative, subcutaneous nodules; exquisitely tender; usually on lower legs but also on upper extremities | More common among girls and women 15–30 years old | Arthralgias (50%); features vary with associated condition | —f |
Sweet syndrome (acute febrile neutrophilic dermatosis) | Yersiniae; upper respiratory infection; inflammatory bowel disease; pregnancy; malignancy (usually hematologic); drugs (G-CSF) | Tender red or blue edematous nodules giving impression of vesiculation; usually on face, neck, upper extremities; when on lower extremities, may mimic erythema nodosum | More common among women and among persons 30–60 years old; 20% of cases associated with malignancy (men and women equally affected in this group) | Headache, arthralgias, leukocytosis | |
Bacillary angiomatosis | Bartonella henselae, B. quintana | Many forms, including erythematous, smooth vascular nodules; friable, exophytic lesions; erythematous plaques (may be dry, scaly); subcutaneous nodules (may be erythematous) | Immunosuppressed individuals, especially those with advanced HIV infection | Peliosis of liver and spleen in some cases; lesions sometimes involving multiple organs; bacteremia | 69 |
Purpuric Eruptions |
Rocky Mountain spotted fever, rat-bite fever, endocarditisg; epidemic typhuse; dengue feverd,e; human parvovirus B19 infectione | — | — | — | — | —f |
Acute meningococcemia | Neisseria meningitidis | Initially pink maculopapular lesions evolving into petechiae; petechiae rapidly becoming numerous, sometimes enlarging and becoming vesicular; trunk, extremities most commonly involved; may appear on face, hands, feet; may include purpura fulminans (see below) reflecting DIC | Most common among children, individuals with asplenia or terminal complement component deficiency (C5–C8) | Hypotension, meningitis (sometimes preceded by upper respiratory infection) | 52 |
Purpura fulminans | Severe DIC | Large ecchymoses with sharply irregular shapes evolving into hemorrhagic bullae and then into black necrotic lesions | Individuals with sepsis (e.g., involving N. meningitidis), malignancy, or massive trauma; asplenic patients at high risk for sepsis | Hypotension | 19, 52 |
Chronic meningococcemia | N. meningitidis | Variety of recurrent eruptions, including pink maculopapular; nodular (usually on lower extremities); petechial (sometimes developing vesicular centers); purpuric areas with pale blue-gray centers | Individuals with complement deficiencies | Fevers, sometimes intermittent; arthritis, myalgias, headache | 52 |
Disseminated gonococcal infection | Neisseria gonorrhoeae | Papules (1–5 mm) evolving over 1–2 days into hemorrhagic pustules with gray necrotic centers; hemorrhagic bullae occurring rarely; lesions (usually <40) distributed peripherally near joints (more commonly on upper extremities) | Sexually active individuals (more often females), some with complement deficiency | Low-grade fever, tenosynovitis, arthritis | 53 |
Enteroviral petechial rash | Usually echovirus 9 or coxsackievirus A9 | Disseminated petechial lesions (may also be maculopapular, vesicular, or urticarial) | Often occurs in outbreaks | Pharyngitis, headache; aseptic meningitis with echovirus 9 | 101 |
Viral hemorrhagic fever | Arboviruses (including dengue) and arenaviruses | Petechial rash | Residence in or travel to endemic areas, other virus exposure | Triad of fever, shock, hemorrhage from mucosa or gastrointestinal tract | 106, 107 |
Thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome | Idiopathic, bloody diarrhea caused by Shiga toxin–generating bacteria (e.g., Escherichia coli O157:H7), deficiency in ADAMTS13 (cleaves von Willebrand factor), drugs (e.g., quinine, chemotherapy, immunosuppression) | Petechiae | Individuals with E. coli O157:H7 gastroenteritis (especially children), cancer chemotherapy, HIV infection, autoimmune diseases, pregnant/postpartum women | Fever (not always present), microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction, neurologic dysfunction; coagulation studies normal | 58, 63 |
Cutaneous small-vessel vasculitis (leukocytoclastic vasculitis) | Infections (including that caused by group A Streptococcus, viral hepatitis), drugs, idiopathic causes | Palpable purpuric lesions appearing in crops on legs or other dependent areas; may become vesicular or ulcerative | Occurs in a wide spectrum of diseases, including connective tissue disease, cryoglobulinemia, malignancy, Henoch-Schönlein purpura (HSP); more common among children | Fever (not always present), malaise, arthralgias, myalgias; systemic vasculitis in some cases; renal, joint, and gastrointestinal involvement common in HSP | |
Eruptions with Ulcers and/or Eschars |
Scrub typhus, rickettsial spotted fevers, rat-bite fevere; rickettsialpox, ecthyma gangrenosumh | — | — | — | — | —f |
Tularemia | Francisella tularensis | Ulceroglandular form: erythematous, tender papule evolves into necrotic, tender ulcer with raised borders; in 35% of cases, eruptions (maculopapular, vesiculopapular, acneiform, or urticarial; erythema nodosum; or EM) may occur | Exposure to ticks, biting flies, infected animals | Fever, headache, lymphadenopathy | 67 |
Anthrax | Bacillus anthracis | Pruritic papule enlarging and evolving into a 1- by 3-cm painless ulcer surrounded by vesicles and then developing a central eschar with edema; residual scar | Exposure to infected animals or animal products, other exposure to anthrax spores | Lymphadenopathy, headache | 10 |