Rash and meningoencephalitis

Cause	Rash	Other Clinical Features	Epidemiology
RMSF	Typically maculopapular rash starting at wrists/ankles and spreading to palms/soles and proximally to trunk; can evolve into petechiae		Travel to south Atlantic and south-central regions of US; also South/Central America; and maybe southern Ontario
Meningococcus	Macular rash on the extremities, evolving into petechiae and purpura	Often in the setting of sepsis
Syphilis	Rash can be just about anything, and may involve palms and soles	May coincide with primary chancre	High-risk sexual exposures
HSV	Vesicular rash, particularly on mucosal surfaces	Painful rash
VZV	Vesicles on erythematous base
Behçet disease	Oral and genital ulcers
WNV	Macular, papular, or morbilliform erythematous rash, mostly on trunk		More common in summer and early fall
Enterovirus	Discrete or confluent maculopapular rash, often involving face, but rash can have a number of appearances
EBV	Maculopapular rash on trunk and arms	Rash is uncommon but possible
Lyme disease	Expanding annular lesion at site of tick bite, can have secondary lesions at distant sites

Further Reading