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Indian Pediatr 2013;50: 717

Febrile Rash and Convalescent Rash of Dengue Fever


AM Vijayalakshmi and A Jayavardhana

Department of Pediatrics, PSG Institute of Medical Sciences and Research,
Peelamedu, Coimbatore 641 004. Tamil Nadu, India.
Email: [email protected]



A 1-year-old boy infant presented with fever for 3 days. On examination he was febrile and his face, trunk and extremities were erythematous which blanched upon pressure (Fig. 1). His platelet count dropped to 83,000 per µL on day 5 of illness. His dengue serology IgM was positive suggestive of primary dengue infection.

Fig. 1 Febrile rash of dengue which blanches upon pressure.

A 9-year-old girl presented with fever for 4 days. On day 8 of illness, when her fever subsided, she developed hypotension. Her platelet count dropped to 15000/ml and hematocrit increased to 42.8%. She was resuscitated with fluid boluses. She developed typical dengue rash of convalescence 3 days after defervescence (Fig. 2). Her dengue serology IgM and IgG were positive, suggestive of secondary dengue infection.

Fig. 2 Convalescent rash of dengue – "White isles in the sea of red".

During the first 24-48 hours of fever, children with dengue fever may develop a transient generalized macular erythematous rash which blanches upon pressure. The convalescent rash of dengue fever appears about 2-3 days after defervescence. It is characterized by generalized confluent petechial rash which does not blanch upon pressure, with multiple small round islets of normal skin. It is otherwise called "white is lands in a sea of red". Some children with this rash may experience generalized pruritus. This rash gradually fades over one week.

 

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