TAILIEUCHUNG - Chapter 054. Skin Manifestations of Internal Disease (Part 16)

Both measles and rubella are seen in unvaccinated young adults, and an atypical form of measles is seen in adults immunized with either killed measles vaccine or killed vaccine followed in time by live vaccine. In contrast to classic measles, the eruption of atypical measles begins on the palms, soles, wrists, and knuckles, and the lesions may become purpuric. The patient with atypical measles can have pulmonary involvement and be quite ill. Rubelliform and roseoliform eruptions are also associated with Epstein-Barr virus (5–15% of patients), echovirus, coxsackievirus, cytomegalovirus, and adenovirus infections. Detection of specific IgM antibodies or fourfold elevations. | Chapter 054. Skin Manifestations of Internal Disease Part 16 Both measles and rubella are seen in unvaccinated young adults and an atypical form of measles is seen in adults immunized with either killed measles vaccine or killed vaccine followed in time by live vaccine. In contrast to classic measles the eruption of atypical measles begins on the palms soles wrists and knuckles and the lesions may become purpuric. The patient with atypical measles can have pulmonary involvement and be quite ill. Rubelliform and roseoliform eruptions are also associated with Epstein-Barr virus 5-15 of patients echovirus coxsackievirus cytomegalovirus and adenovirus infections. Detection of specific IgM antibodies or fourfold elevations in IgG antibodies allows the proper diagnosis. Occasionally a maculopapular drug eruption is a reflection of an underlying viral infection. For example about 95 of the patients with infectious mononucleosis who are given ampicillin will develop a rash. Of note early in the course of infections with Rickettsia and meningococcus prior to the development of purpura the lesions may be erythematous macules and papules. This is also the case in chickenpox prior to the development of vesicles. Maculopapular eruptions are associated with early HIV infection early secondary syphilis typhoid fever and acute graft-versus-host disease. In the last lesions frequently begin on the palms and soles the macular rose spots of typhoid fever involve primarily the anterior trunk. The prototypic scarlatiniform eruption is seen in scarlet fever and is due to an erythrotoxin produced by group A 0-hemolytic streptococcal infections most commonly pharyngitis. This eruption is characterized by diffuse erythema which begins on the neck and upper trunk and red follicular puncta. Additional findings include a white strawberry tongue white coating with red papillae followed by a red strawberry tongue red tongue with red papillae petechiae of the palate a facial flush with .