Thread by @Ashka_TxID

#IDboardpearls #IDtwitter

Derm… ☠️ Let’s break it down starting with viral exanthems. Follow the 🧶

🚨Coxsackievirus:

1️⃣✋🏼,🦶🏼, & mouth disease - Coxsackie A > Coxsackie B or EV71
🔎 - 😣 ulcerative lesions on hard palate, 👅, buccal mucosa ➡️ vesicular rash on 🤲🏼 &🦶🏼

2️⃣ Atypical HFMD
🔎- vesiculobullous rash or crusted papules (Gianotti-Crosti syndrome). Associated with skin and 💅🏼 peeling. At sites of atopic eczema (eczema coxsackium)

🚨Parvovirus B19:

1️⃣ Erythema infectiosum - Fifth disease
🔎- 👋🏼 cheek syndrome ➡️ lacy erythematous

rash on truck & limbs

2️⃣ Papular-purpuric (🧤&🧦) syndrome
🔎- pruritic erythema & edema of distal limbs (sharp demarcation at wrists/ankles ➡️ petechial or purpuric

🚨Measles:

1️⃣ Measles exanthem
🔎- starts behind the 👂🏼then spreads to face, trunk, limbs (🤲🏼🦶🏼)

2️⃣ Atypical

measles - seen in pts who received 💉 with killed measures virus (🛑 in 1967)
🔎- urticarial, vesicular, maculopapular, or hemorrhagic rash + peripheral or 🫁 edema

🚨Rubella:
🔎- maculopapular rash. Forehead ➡️ face ➡️ trunk & limbs. 📌point lesions

🚨Primary varicella: 🐔pox

🔎- cluster of lesions that “crop” at different stages (papule ➡️ vesicle ➡️ pustule ➡️ crusted pustule), pruritic, not 😣 vs👇🏼

🚨Herpes Zoster: 😣 vesicular rash limited to dermatomal distribution

1️⃣ Disseminated - > or = 2 noncontiguous dermatomes or visceral/🧠 involvement

2️⃣ Herpes zoster ophthalmicus - vesicles around V1 distribution
🔎- 👁 (keratitis or retinal involvement), Hutchinson’s sign (vesicle on 👃🏼= involvement of nasociliary branch of V1 nerve)

3️⃣ Herpes zoster oticus - Ramsay-Hunt syndrome
🔎- vesicles on 👂🏼+ ipsilateral facial palsy

🚨Herpes simplex virus:

1️⃣ Herpes gladiatorum - 👀 with 🤼 & contact sports
🔎- vesicular rash on face & limbs

2️⃣ Herpes Whitlow - 👀 with 🦷 & healthcare workers
🔎- vesicular rash on 👉🏼

3️⃣ Eczema herpeticum - Kaposi’s varicelliform eruption
🔎- new 😣 skin lesions on

pre-existing skin disease.

💡👆🏼also seen with what? 🤔

4️⃣ Recurrent erythema multiforme
🔎- vesicular 👄 lesion + 🤲🏼 with 🎯 lesion

💡EBV w/ Gianotti-Crosti syndrome & EM. What 💊 causes a rash w/ EBV? 🤔

🚨Human Herpes virus 6&7:

1️⃣ Exanthem subitum - sixth disease or

roseola infantum. Caused by HHV6B > HHV7
🔎- 🌹pink muculopapular blanching rash, non-pruritic, face & trunk

🚨Smallpox:
🔎- lesions that develop at the same stage (papule ➡️ vesicle ➡️ pustule ➡️ crusted pustule), deeper lesions, involve primarily face & extremities

💡👆🏼vs

what disease? 🤔

🚨HIV: acute HIV can cause a non-specific rash or

1️⃣ Kaposi sarcoma (cutaneous) - caused by HHV8
🔎- purple/brown macules in various sizes, generalized

2️⃣ Bacillary angiomatosis - caused by Bartonella quintana/henselae
🔎- papular vs plaque/nodular lesions

3️⃣ Eosinophilic pustular folliculitis
🔎- pruritic crops of papules/pustules

4️⃣ Seborrheic dermatitis, psoriasis, onychomycosis

🚨Dengue:
🔎 - ☀️burn rash, blanching, generalized, white areas of sparing

🚨Chikungunya:
🔎- morbilliform rash w/ hypermelanosis & desquamation 🤲🏼

Test what your learned with this #IDboardreview question by @IUIDfellowship

👇🏼

https://twitter.com/IUIDfellowship/status/1269072919835148291

Here’s more info on HIV-related skin manifestations along with more amazing questions by @BCMIDFellowship

👇🏼

https://twitter.com/bcmidfellowship/status/1311364255753568259