FIGURE 324-1.

Cutaneous manifestations of some common systemic or widely disseminated diseases.

A, Generalized macular rash of dengue; rash usually appears after 4 or 5 days, but an earlier, faint, flushlike rash also may be present. B, Viral hemorrhagic fever due to yellow fever infection; typical signs of viral hemorrhagic fevers include bleeding from orifices and intravenous sites as well as diffuse petechiae or ecchymoses, especially over pressure points. C, Sepsis due to Vibrio vulnificus infection after ingestion of contaminated shellfish; hemorrhagic bullae are seen in sepsis, envenomation, and autoimmune disease but not with viral hemorrhagic fevers. D, Migratory lesions of infection with Gnathostoma spinigerum after ingestion of uncooked freshwater fish; larvae often leave a mildly hemorrhagic track. E, Faint, papular, highly pruritic dermatitis due to Onchocerca volvulus infection after travel to Sierra Leone; travelers who may not present for a year or more after travel are usually lightly infected and have no ocular manifestation. F, Typical eschar of African tick typhus due to Rickettsia africae; widely disseminated petechial vasculitic lesions are often present as well. G, Verruga peruana due to chronic infection with Bartonella bacilliformis, present only if the patient is not treated for and survives the acute bacteremic phase. H, Painless lesions of cutaneous anthrax; surrounding edema is characteristic, and the base quickly evolves to become totally black and necrotic. I, Spider bite due to Loxosceles laeta; unlike anthrax, spider bites are painful and usually have very irregular borders without significant edema.

(Courtesy Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; and the Gorgas Memorial Institute, University of Alabama, Birmingham, AL.)