12. Infectious rash on palms and solesInfectious rash on palms and soles
Erythema multiforme
Enteroviral infection
Coxsackievirus
Echovirus
Rocky Mountain spotted fever
51. An aerial view of a crowd surrounding a massiveAn aerial view of a crowd surrounding a massive
city auditorium in San Antonio,TX awaitingcity auditorium in San Antonio,TX awaiting
polio immunization, 1962polio immunization, 1962.
53. A 13-month old white male developedA 13-month old white male developed
high fever that persisted for 4 dayshigh fever that persisted for 4 days
without recognized causewithout recognized cause.. The childThe child
appeared relatively well and the feverappeared relatively well and the fever
subsided to be followed by asubsided to be followed by a
maculopapular rash that began on themaculopapular rash that began on the
trunk and spread to involve the facetrunk and spread to involve the face
and extremitiesand extremities.
96. •Allergic angioedema is characterized by
swelling, hives, or both in reaction to
environmental factors such as food, an
insect sting or bite, cold, heat, latex, or a
drug. Usually, these environmental factors
provoke histamine release that leads to
swelling, hives, or both.
97.
98.
99.
100.
101.
102. •urticaria multiforme
a benign hypersensitivity rash commonly
mistaken for more severe diseases such as
erythema multiforme (EM) and conditions
associated with purpuric lesions.
103. The rash spared her palms, soles andThe rash spared her palms, soles and
mucus membranesmucus membranes
palpable pink wheels
intensely pruritic, the palpable pink wheels
had developed central duskiness that
looked similar to bruising, and her hands,
feet and face were edematous
There were no target lesions
104.
105.
106.
107.
108.
109. •Erythema multiforme with typical red
papules evolving into target lesions on his
arms and legs. The eruption was
minimally itchy and resolved without
treatment in 10 days. He did not have
mucous membrane involvement.
110.
111.
112.
113. •This healthy 5-year-old boy developed itchy
eyes for 2 days followed by fever and sore
throat. He was started on amoxacillin,
acetominophen, and ibuprofen and 24 hours
later developed red macules, papules, and
erosios of the face, eyes, and mouth. The
lesions progressed over the face, scalp, upper
trunk, and proximal extremities for 3-4 days,
stabilized, and healed over 7 days. Mucous
membrane involvement particularly the eyes and
mouts was severe.
114. •This 10-year-old boy had an intermittent fever, headache, and
stomachache for 2 weeks before developing red cheeks and ears.
On the following day red patches blossomed on his arms, legs,
neck, and chest which became blistered within hours. Erosions
spread throughout his mouth and conjunctivae, and he was
admitted to the pediatric intensive care unit for management of
fluids, pain, and possible infection. Lesions progressed for a week,
and on day 4 he received intravenous immumoglobulin. He required
a central line for fluid resuscitation, fentanyl for pain, and a urinary
catheter. He was discharged home on day 15 and developed
desquamation of the palms and soles 2 days later. Fortunately he
recovered without serious complications. Nails shed 2 months later,
and mottled pigmentation persisted.
120. •day 10-healingday 10-healing
erosions anderosions and
crusts on lips;crusts on lips;
generalizedgeneralized
desquamationdesquamation
with pink basewith pink base
and coarseand coarse
brown scalebrown scale
123. •This healthy 8-year-old boy developed crusted erosions on his lips,
erosions on his palate and buccal mucosa, and discrete and
confluent red papules some with central bullae on his upper chest
and distal extremities including the palms and soles. His eyes were
clear. He was admitted to the hospital for rehydration, because he
was unable to eat of drink. He was treated with oral steroid, and was
discharged 3 days later with good oral intake and decreased oral
pain. He had clinical features overlapping Stevens-Johnson
syndrome and erythema multiforme (classic Von Hebra type). The
lack of conjunctival involvement is unusual for Stevens-Johnson
syndrome, but the involvement of the mouth, trunk, and extremities
was more typical. The involvement of the distal extremities and the
presence of target lesions on the dorsum and ventral surfaces of his
hands and feet is typical of erythema multiforme.
129. •right and left eyes
showing moderate
conjunctival
hyperemia and
mucoid discharge
with ulcerations on
the eyelid margins
and
ankyloblepharon
(eyelids are stuck
on the eye ball).
131. •This 5-year-old boy, who was on no medications,
developed fever and sore throat followed 3 days later by
an erosive conjunctivitis, oral mucositis, urethritis, and a
progressive generalized erythema, blistering, and
ulcerations. He was admitted to the intensive care unit
where he received pulsed high dose intravenous steroids
and intravenous immunoglobulin 2 grams/kg over 3
days, but continued to progress to 100% skin and
mucous membrane involvement. Over the subsequent 4
weeks he gradually improved and was discharged from
the acute care hospital to a longterm pediatric facility for
occupational and physical therapy
