Journal
TROPICAL MEDICINE AND INFECTIOUS DISEASE
Volume 7, Issue 5, Pages -Publisher
MDPI
DOI: 10.3390/tropicalmed7050070
Keywords
measles virus; exanthema; Treponema pallidum; secondary syphilis
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Funding
- Japan Agency for Medical Research and Development (AMED) [JP19m0108003, 21wm0225010h0102]
- Osaka University ASEAN campus project
- Mahidol University
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Fever and rash, also known as febrile exanthem, are commonly caused by infection by microorganisms. While viruses are frequently responsible, bacteria can also cause rashes. Some microbes may exhibit distinctive features during illness, but coinfections can make clinical diagnosis challenging.
Fever and rash as manifestations of infection by microorganisms are collectively known as febrile exanthem. Since viruses are more frequently associated with fever and rash, these symptoms are thus impetuously termed viral exanthem. However, bacteria represent a frequently overlooked infectious etiology causing rash in humans. In addition, certain microbes may exhibit pathognomonic features that erupt during illness and facilitate clinical diagnosis. Conversely, coinfections often obscure the clinical characteristics of the primary disease and further challenge clinicians attempting to reach a diagnosis. We retrospectively looked at de-identified clinical data of a patient who presented to the Hospital for Tropical Diseases in Bangkok in July 2019 with complaints of fever and rash. The case involved a 35-year-old who presented with a 3-day history of fever, respiratory symptoms, myalgia, conjunctivitis, diarrhea, and a generalized maculopapular rash. On examination, the patient was febrile, tachycardic, and tachypneic, with a mean arterial pressure of 95 mmHg. A differential white blood cell count showed: leukocytes, 5800/mu L; neutrophils, 4408/mu L; lymphocytes, 406/mu L; and platelets, 155,000/mu L. Striking findings involving the integumentary system included Koplik's spots and generalized maculopapular rash. Further serology revealed positive immunoglobulin (Ig)M and IgG for both measles and rubella virus, including reactive serology for Treponema pallidum. Here we describe the clinical course and management of this patient.
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