The time of year can be a clue to certain diagnoses. A history of recent travel, woodland or animal exposure, drug ingestion or contact with ill persons should be noted. 1 – 3Ī detailed history can be quite helpful in identifying the cause of fever and a rash. This article reviews common diagnoses for fever and a rash and suggests a logical approach to obtaining the correct diagnosis. In addition, the clinical picture can vary considerably, and the family physician may need to quickly decide about initiating empiric therapy or isolation. Hospitalization, isolation and antimicrobial therapy often must be considered when a patient presents with fever and a rash.Įvaluating the patient who presents with fever and a rash can be challenging because the differential diagnosis is extensive and includes minor and life-threatening illnesses. Because the severity of these illnesses can vary from minor (roseola) to life-threatening (meningococcemia), the family physician must make prompt management decisions regarding empiric therapy. Although laboratory studies can be useful in confirming the diagnosis, test results often are not available immediately. A thorough history and a careful physical examination are essential to making a correct diagnosis. Potential causes include viruses, bacteria, spirochetes, rickettsiae, medications and rheumatologic diseases. Rashes can be categorized as maculopapular (centrally and peripherally distributed), petechial, diffusely erythematous with desquamation, vesiculobullouspustular and nodular. Diseases that present with fever and rash are usually classified according to the morphology of the primary lesion. The differential diagnosis for febrile patients with a rash is extensive.
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