Background: Besides the six classical exanthems, other exanthems may occur, differing in morphology and causative agent (atypical exanthems). Their aetiological diagnosis is difficult but crucial for both the patient and community concerning issues such as time off school, immunizations, and risks for pregnant women and immunocompromised patients.
Objectives: To investigate whether morphology, associated symptoms and laboratory results can help to determine the aetiology of atypical exanthems.
Methods: We studied 112 consecutive out-patients attending two university dermatology departments. Peripheral blood mononuclear cells (PBMC) and throat, rectal and vaginal swabs were studied to identify viral and bacterial growth. Nested polymerase chain reaction was performed on PBMC and plasma using specific primers for herpesviruses. Serology for common viruses was investigated.
Results: We classified the exanthems into seven morphological patterns: macular erythema (32 patients), papular erythema (eight), maculopapular erythema (42), maculopapular erythema with petechiae (seven), erythema with vesiculation (11), erythema with pustules (five) and urticaria (seven). On the basis of morphology, in concert with the associated symptoms and laboratory results, we found a causal relationship in 76 patients (68%): 25 cases due to drugs, 32 to viruses, 16 to bacteria and three to parasites. A good correspondence between morphology and aetiology was found. The erythematous-vesicular pattern was exclusive to viral infections and was often accompanied by enanthema. The erythemato-pustular and papular patterns were found only in drug-related cases and in some undiagnosed cases. In contrast, the macular and maculopapular patterns were almost evenly distributed among the various aetiologies, although their colour was duskier in the drug-related exanthems. Severe pruritus was associated with drug-related exanthems.
Conclusions: This is the largest series of consecutive patients with atypical exanthems reported. Their morphology and their association with pruritus or constitutional symptoms proved to be important diagnostic clues.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1046/j.1365-2133.2002.04826.x | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Non-Classical Complications of Adult-Onset Still's Disease: A Multicenter Spanish Study.
J Clin Med
January 2025
Department of Pediatric Rheumatology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Barcelona, Spain.
To investigate the prevalence and clinical spectrum of atypical or non-classical complications in adult-onset Still's disease (AOSD) beyond macrophage activation syndrome (MAS) and to identify factors linked to their occurrence. Multicenter cross-sectional study of AODS cases included in the Spanish registry on Still's disease. This study included 107 patients (67% women), of whom 64 (59.
View Article and Find Full Text PDFAn Unusual, Symmetric Rash on Both Forearms in a 94-Year-Old Patient A Clinicopathological Challenge and Diagnostic Pitfall.
J Cutan Pathol
February 2025
Department of Dermatology, University Hospital Basel, Basel, Switzerland.
Article Synopsis
- Trichophyton rubrum (T. rubrum) typically causes minor skin infections, mostly affecting healthy individuals, but can lead to serious infections in immunocompromised patients.
- A unique case involved a 94-year-old man with an invasive T. rubrum infection on both forearms, which resembled cutaneous blastomycosis.
- Diagnosis is complicated as T. rubrum can present with large spore-like structures that mimic Blastomyces dermatitidis, underscoring the necessity for culture or PCR testing for accurate identification.
Emerging and re-emerging viral exanthems among children: what a physician should know.
Trans R Soc Trop Med Hyg
January 2025
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Viral exanthems can present with diverse morphologies of rash, including macular, maculopapular, papular, urticarial and vesicular, or sometimes a combination of these. There has been an increasing trend towards emerging and re-emerging viral exanthems in recent years, the cause of which is multifactorial, including changing environmental conditions and altered host-vector-agent interaction. The significant temperature variations brought on by climate change and ever-increasing international travel has modified the host-agent interactions, and many re-emerging viral illnesses are now presenting with atypical presentations, including an increased frequency of affliction across broader age groups and heightened manifestations often posing as 'great imitators' mimicking a myriad of other dermatoses.
View Article and Find Full Text PDFCorymbiform syphilis: A rare dermatological presentation.
Int J STD AIDS
December 2024
Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta.
Syphilis is often referred to as the 'great imitator' due to its diverse clinical manifestations throughout its clinical stages and polymorphic nature. We report a case of a 24-year-old man-who-has-sex-with-men presenting with an atypical syphilitic rash on the trunk, with a corymbiform appearance. This case highlights the necessity for clinicians to maintain a high index of suspicion for sexually transmitted infections, especially when there are skin manifestations of an uncertain nature.
View Article and Find Full Text PDFSyphilis Should not be Overlooked in any Individual, Irrespective of their Condition.
Eur J Case Rep Intern Med
August 2024
Infectious Disease Department, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France.
Introduction: Syphilis remains a significant challenge in public health, largely because of its diverse clinical manifestations, often resulting in underdiagnosis especially among patients with neurogenic disability.
Case Description: We present a case of neurosyphilis in a 63-year-old patient with a spinal cord injury. Despite syphilis being a well-established sexually transmitted infection, the exacerbation of neurological and dermatological symptoms during physical examination prompted an investigation into alternative causes beyond the patient's pre-existing paraparesis, ultimately resulting in the diagnosis of neurosyphilis.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!