“The Thinker’s Rash…”
MAKES A MRC “Makes a Mark”
Measles Arthritis Kawasaki Endocarditis Syphilis
Allergy/Atopy
Meningococcemia Rickettsia Coxsackie
Measles
Koplik spots appear in the mouth before the macular rash that starts at the hairline, and progresses to the extremities.
Arthritis
Reactive arthritis (Reiter’s syndrome) — genitourinary infection, but may also occur after gastrointestinal illness; rash on palms and soles is called keratoderma blenorrhagicum
Kawasaki
The rash of Kawasaki Disease is notoriously variable. Look for the syndrome of conjunctivitis, rash (any), adenopathy, strawberry tongue, and/or desquamation. A Kawasaki-like syndrome is also seen with MIS-C. The rash on the palms and soles of Kawasaki Disease can be mimicked by other conditions, such as measles, Epstein-Barr virus, echovirus, among others.
Endocarditis
The Modified Duke Criteria apply to both adults and children. 3 minor criteria are enough to qualify for “Possible Infectious Endocarditis”.
Syphilis
Secondary syphilis may present on the palms and soles. Remember, syphilis is the “great imitator”; the rash may be variable, but will often match the clinical presentation as a whole (i.e. history and physical examination).
Allergy/Atopy
Especially dyshidrotic eczema
Meningococcus
The rash and presentation are dynamic.
Rickettsia
Rickettsia Spotted Fevers can be found worldwide.
Coxsackie
Aren’t you glad you saved this for last?
Selected references
Abdad MY, Abou Abdallah R, Fournier PE, Stenos J, Vasoo S. A Concise Review of the Epidemiology and Diagnostics of Rickettsioses: Rickettsia and Orientia spp. J Clin Microbiol. 2018 Jul 26;56(8):e01728-17. doi: 10.1128/JCM.01728-17. PMID: 29769278; PMCID: PMC6062794.
Dixon G, Christov G. Infective endocarditis in children: an update. Curr Opin Infect Dis. 2017 Jun;30(3):257-267. doi: 10.1097/QCO.0000000000000370. PMID: 28319472.
Elsner P, Agner T. Hand eczema: treatment. J Eur Acad Dermatol Venereol. 2020 Jan;34 Suppl 1:13-21. doi: 10.1111/jdv.16062. PMID: 31860736.
Jubber A, Moorthy A. Reactive arthritis: a clinical review. J R Coll Physicians Edinb. 2021 Sep;51(3):288-297. doi: 10.4997/JRCPE.2021.319. PMID: 34528623.
Keuning MW, Kamp GA, Schonenberg-Meinema D, Dorigo-Zetsma JW, van Zuiden JM, Pajkrt D. Congenital syphilis, the great imitator-case report and review. Lancet Infect Dis. 2020 Jul;20(7):e173-e179. doi: 10.1016/S1473-3099(20)30268-1. Epub 2020 Jun 2. PMID: 32502432.
Kimmis BD, Downing C, Tyring S. Hand-foot-and-mouth disease caused by coxsackievirus A6 on the rise. Cutis. 2018 Nov;102(5):353-356. PMID: 30566537.
Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. PMID: 28673424.
Muzumdar S, Rothe MJ, Grant-Kels JM. The rash with maculopapules and fever in children. Clin Dermatol. 2019 Mar-Apr;37(2):119-128. doi: 10.1016/j.clindermatol.2018.12.005. Epub 2018 Dec 5. PMID: 30981292.
Saguil A, Kane SF, Lauters R, Mercado MG. Hand-Foot-and-Mouth Disease: Rapid Evidence Review. Am Fam Physician. 2019 Oct 1;100(7):408-414. PMID: 31573162.
Satyaputra F, Hendry S, Braddick M, Sivabalan P, Norton R. The Laboratory Diagnosis of Syphilis. J Clin Microbiol. 2021 Sep 20;59(10):e0010021. doi: 10.1128/JCM.00100-21. Epub 2021 May 12. PMID: 33980644; PMCID: PMC8451404.
Tugelbayeva А, Ivanova R, Goremykina М, Rymbayeva Т, Toktabayeva B. REACTIVE ARTHRITIS IN CHILDREN (REVIEW). Georgian Med News. 2021 Feb;(311):130-135. PMID: 33814406.
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