A not so common cause for fever with rashes

Murali Narasimhan, Saju A. Sathar, Ramachandran Ramakrishnan


Skin rashes that appear during febrile illnesses can be due to various infectious diseases and non-infectious conditions that can range from mild self-limiting diseases to potentially life threatening conditions. Hence a comprehensive knowledge of these diseases is required. A comprehensive history must be taken, including intake of any medications, contact with animals, recent travel, and trekking in various natural environments. Complete and thorough physical examination can provide clues to early diagnosis. Here we report a case which presented with high grade fever, generalized blanching maculopapular rashes, and headache. Close examination revealed a scrotal ulcer leading to the diagnosis of scrub typhus which was confirmed by ELISA and treated successfully with doxycycline.



Maculopapular rash, Scrotal ulcer, Eschar

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Kang JH. Febrile illness with skin rashes. Infection Chemotherap. 2015;47(3):155-66.

Tamura A, Ohashi N, Urakami H, Miyamura S. Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen. nov., as Orientiatsutsugamushi comb. nov. Int J Syst Bacteriol. 1995;45(3):589-91.

Lerdthusnee K, Khuntirat B, Leepitakrat W, Tanskul P, Monkanna T, Khlaimanee N, et al. Scrub Typhus. Annals of the New York Academy of Sciences. 2003;990(1):25-35.

Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, et al. Scrub typhus among hospitalised patients with febrile illness in South India: magnitude and clinical predictors. J Infection. 2006;52(1):56-60.

Sinha P, Gupta S, Dawra R, Rijhawan P. Recent outbreak of scrub typhus in North Western part of India. Indian J Med Microbiol. 2014;32(3):247.

Mahajan SK. Scrub typhus. JAPI. 2005;53(955):269.

Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD. Diagnosis of scrub typhus. Am J Trop Med Hygiene. 2010;82(3):368-70.

Blacksell SD, Bryant NJ, Paris DH, Doust JA, Sakoda Y, Day NP. Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to a lot of confusion. Clin Infectious Dis. 2007;44(3):391-401.

Thomas EA, John M, Kanish B. Mucocutaneous manifestations of dengue fever. Indian J Dermatol. 2010;55(1):79.

Vaishnani JB. Cutaneous findings in five cases of malaria. Indian J Dermatol Venereol Leprol. 2011;77(1):110.