Ann Dermatol.  2012 Nov;24(4):420-425. 10.5021/ad.2012.24.4.420.

Clinical Features and Etiology of Adult Patients with Fever and Rash

• Tabak F
• Murtezaoglu A
• Tabak O
• Ozaras R
• Mete B
• Kutlubay Z
• Mert A
• Ozturk R

• KMID: 2266036
• DOI: http://doi.org/10.5021/ad.2012.24.4.420

Abstract

BACKGROUND
Patients with fever and rash often pose an urgent diagnostic and therapeutic dilemma for the clinician. The nonspecificity of many fever and rash syndromes mandates a systemic approach to diagnosis.
OBJECTIVE
We aimed to determine the etiology of fever and rash in 100 adult patients followed-up as in- or outpatients prospectively.
METHODS
All the patients, who presented with rash and fever, were followed-up prospectively and their clinical and laboratory studies were evaluated.
RESULTS
The median age was 35 years (14~79 years); 45 were female and 55 were male. Patients were divided into 3 groups according to the etiology: infectious (50%), noninfectious (40%) and undiagnosed (10%). The most common type of rash was maculopapular, and the most common 5 causes were measles, cutaneous drug reactions, varicella, adult-onset Still's disease (ASD) and rickettsial disease. Viral diseases among infectious causes and cutaneous drug reactions, among the noninfectious causes, were determined as the main diseases. The mortality rate was 5% and the reasons of mortality were as follows: toxic epidermal necrolysis (2 patients), ASD (1), staphylococcal toxic shock syndrome (1) and graft-versus-host disease (1).
CONCLUSION
Adult patients with fever and rash had a wide differential diagnosis. The most common type of rash was determined as maculopapular, and the most frequent five diseases were measles, drug reactions, chickenpox, ASD and rickettsial infection. Viral diseases among infectious causes and drug reactions among noninfectious causes were determined as the leading etiologies.

Keyword

Exanthema; Fever; Infection

MeSH Terms

Adult
Chickenpox
Diagnosis, Differential
Epidermal Necrolysis, Toxic
Exanthema
Female
Fever
Graft vs Host Disease
Humans
Male
Measles
Outpatients
Prospective Studies
Shock, Septic
Still's Disease, Adult-Onset
Virus Diseases

Figure

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  Fig. 1 Rash after using amoxicilline in patient with infectious mononucleosis.

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  Fig. 2 Purpura fulminans after drug use.

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  Fig. 3 Pyoderma gangrenosum in a patient with ulcerative colitis.

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