Maculopapular rash

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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150 Maculopapular rash

Instruction

Would you like to perform a general examination of this patient?

Look at this patient.

Salient features

History

• Ask whether or not the rash itches

• Ask where the rash started and ask the patient to describe its evolution

• Take a drug history (e.g. ampicillin, cephalosporins)

• History of fever (viral exanthems)

• Mucosal involvement.

Examination

• Reddish, blotchy maculopapular rash over the trunk (check the chest, back and axillae) and limbs (Fig. 150.1)

image

Fig. 150.1 Drug eruption (ampicillin): asymmetric, confluent maculopapular eruption.

(With permission from Habif 2009.)

Proceed as follows:

• Palpate the surface of the rash to confirm your inspectory findings

• Check the mucous membranes of the mouth

• Tell the examiner that you would like to ask the patient some questions:

• Examine for lymph nodes (glandular fever): some examiners may expect you to examine the lymph nodes as a part of the general examination. If lymph nodes are palpable, then examine all groups (cervical, supraclavicular, axillary and inguinal).

Note: Avoid waffling descriptions such as ‘skin rash’.

Diagnosis

This patient has a maculopapular rash (lesion) caused by ampicillin ingestion (aetiology), which usually resolves on discontinuing the drug (functional status).

Questions

What is your differential diagnosis?

• Drug-induced rash

• Glandular fever (rash seen in only 3% of patients with infectious mononucleosis but approaches 100% when these patients take ampicillin).

Viral exanthems (measles, rubella).

What is your differential diagnosis when the rash is associated with lymphadenopathy?

• Glandular fever

• Lymphoproliferative disorders such as Hodgkin’s disease

• HIV infection.

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