Which cutaneous findings are characteristic of aseptic meningitis?

Updated: Jul 17, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Skin manifestations may suggest the diagnosis of aseptic meningitis from certain causes. Examples include the rash of varicella zoster, the genital lesions of HSV-2, or a mild maculopapular rash occurring in the summer and fall months with some enteroviruses.

Rash from enteroviral infections usually accompanies the onset of fever and persists for 4-10 days. In infections due to coxsackieviruses A5, 9, or 16 or echoviruses 4, 6, 9, 16, or 30, the rash is typically maculopapular and nonpruritic, may be confined to the face and trunk, or may involve extremities, including the palms and soles.

In coxsackievirus A16 and, rarely, in other group A serotype infections, a vesicular rash may involve the hands, feet, and oropharynx. Herpangina, characterized by gray vesicular lesions on the tonsillar fossae, soft palate, and uvula, can accompany infection caused by group A coxsackievirus. With echovirus 9 infections, a petechial rash resembling meningococcemia typically is observed.


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