General: In addition to HIV itself, the most common causes of rash and fever in HIV patients are allergic drug reactions, infections, and a cancer called Kaposi's sarcoma (KS).
Acute HIV infection: The first stage of HIV, known as the primary or acute infection, may cause symptoms of fever and skin rash. This is because the virus is multiplying rapidly in the body and infecting immune cells. This phase generally lasts several weeks. An estimated 80-90% of HIV patients experience flu-like symptoms, including fever, skin rash, sore throat, enlarged lymph nodes, and cough.
Drug reactions: Some HIV patients may develop allergic reaction to medications. This happens when the body overreacts to a substance in the medication. During an allergic reaction, the body mistakes a substance in the medication for a harmful invader, such as bacteria, and launches an attack. While any type of medication can potentially trigger an allergic reaction, antibiotics such as penicillin are the most common trigger. Anti-HIV drugs (antiretrovirals) may also cause an allergic reaction. A skin rash and fever are symptoms of a severe and potentially life threatening allergic reaction called anaphylaxis. If not treated immediately, this reaction can lead to shock, unconsciousness, and death.
Some patients may develop a severe skin rash called Stevens-Johnson syndrome (SJS) as an allergic reaction to medications. SJS is potentially life threatening because, in severe cases, lesions can develop on the internal organs and cause scarring, which often leads to loss of function of the organ systems.
Infections: HIV patients are vulnerable to infections because the virus infects and destroys the immune system. Many types of bacteria, viruses, fungi, and parasites may cause illnesses with symptoms of skin rash and fever. Among the most common infections to cause such symptoms are staphylococcus, gonorrhea, syphilis, genital herpes virus, chicken pox, bacterial meningitis (infection of the membrane that surrounds the brain and spinal cord), a viral infection called fifth disease, human papillomavirus (HPV), hepatitis B (liver infection), cryptococcus, histoplasmosis, pneumocystis, scabies, and parasitic infections called leishmaniasis.
Kaposi's sarcoma: A cancer called Kaposi's sarcoma (KS) may cause fever and rash in HIV patients. This cancer develops in connective tissues, such as bone, cartilage, fat, blood vessels, muscle, or tissues related to tendons or ligaments. Patients typically suffer from lesions on the skin, which appear as raised blotches or lumps that may be purple, brown, or red.
General: The duration and severity of fever and rash in HIV patients vary, depending on the cause. Additional symptoms may also be present, depending on the cause.
Fever: Patients who have a fever may experience chills, increased sweating, shivering, and warm skin.
Rash: There are many different forms of rashes, which vary in their appearance, location, severity, and duration. Some rashes may contain blisters, flat or raised bumps, pimples, or dry or flaky skin. The skin may be red and/or itchy. If the skin itches, it is called pruritus. The amount of skin affected may be limited to an isolated area, or it may affect multiple areas of the body.
General: A fever and rash are easily identified during a physical examination. However, because they are symptoms of an underlying medical condition, the cause must be identified in order to treat the patient. During a physical examination, a healthcare provider will take a careful medical and social history to determine the underlying cause. Medical tests may be necessary.
Physical examination and medical history: The healthcare provider will assess how long the patient has had the rash, as well as gather information regarding history of allergies, infections, or other skin diseases. It is important to know any change in medications, especially if the patient has taken a new drug, herb, or supplement.
Allergen-specific immunoglobulin (IgE) test: An allergen-specific immunoglobulin E (IgE) test, commonly referred to as radioallergosorbent test (RAST®), may be used to determine whether the patient is allergic to particular substances, such as medications or foods. Currently, more than 550 allergens are available for determinations.
This test is less accurate than a skin test. It is usually performed in patients who also have severe skin diseases (such as eczema or psoriasis) that make it difficult to interpret a skin test. During the procedure, a sample of the patient's blood is sent to a laboratory for testing. The allergen is combined with the blood to determine whether the patient has immunoglobulin E (IgE) antibodies to the allergen. Antibodies are substances that identify and bind to foreign invaders in the body. If the patient has IgE antibodies, an allergy is diagnosed.
Biopsy: A biopsy is the only definitive diagnostic test for Kaposi's sarcoma. During the procedure, a sample of tissue is taken from the patient. The tissue sample may be taken from the skin (punch biopsy), gastrointestinal tract (endoscopic biopsy), tissue that lines the lungs and the inside of the chest wall (pleural biopsy), or lung tissue (transbronchial biopsy). The sample is then analyzed under a microscope for cancerous cells. If cancerous cells are present, Kaposi's sarcoma is diagnosed.
Blood test: A blood tests may be performed to determine whether the patient has a bacterial or viral infection. The patient's blood sample is analyzed under a microscope for bacteria or viruses.
KOH (potassium and hydroxide) preparation: A KOH (potassium and hydroxide) preparation test is used to determine whether a fungal infection is causing the symptoms. During this test, a healthcare provider will gently scrape the skin with a blunt edge (such as the edge of a microscope slide). The sample of scraped skin is then combined with a substance called potassium hydroxide (KOH). This solution allows the healthcare provider to see the fungus (if it is present) under a microscope.
This procedure is not usually painful because only a tiny amount of skin is needed. Patients may feel a slight pressure sensation when the skin is scraped.
Skin test: A skin test may be used to determine whether the rash is caused by an allergic reaction. During the test, the skin is exposed to the suspected allergens that may be triggering an allergic reaction and observed for an allergic reaction. If the allergen triggers an allergic reaction, the patient will develop reddening, swelling, or a raised, itchy red wheal (bump) that looks similar to a mosquito bite. The healthcare provider will measure the size of the wheal and record the results. The larger the wheal, the more severe the allergy.
Tzanck test: A tzanck test is used to determine whether a viral infection called herpes is causing the symptoms. The virus may be suspected if the patient has a rash that contains blisters. During the procedure, a small area of the skin is numbed, and a blister is opened. The healthcare provider will scrape a small sample of the fluid and skin from the blister, and it will be analyzed under a microscope for the virus. If the virus is present, a positive diagnosis for herpes is made.
Anaphylaxis: A skin rash and fever may be symptoms of a severe and potentially life-threatening reaction called anaphylaxis. The most serious symptoms of anaphylaxis include chest pain, difficulty breathing, shock, and loss of consciousness, all of which can be fatal. Patients should seek immediate medical treatment if these symptoms develop.
Febrile seizure: A febrile seizure occurs when an infant or young child develops a seizure or convulsions when he/she has a fever higher than 102 degrees Fahrenheit. Symptoms may include shaking or jerking of the arms or legs, fixed stare, eyes rolling back, heavy breathing, drooling, and bluish skin. Patients who experience these symptoms should be taken to the emergency department of a nearby hospital immediately.
Infection: Some infections that cause fever and rash may spread to multiple parts of the body and cause organ damage. For instance, a liver infection called hepatitis can potentially lead to liver failure. Therefore, HIV patients who experience symptoms of fever and rash should consult their healthcare providers to diagnose and treat the underlying cause.
Kaposi's sarcoma: Kaposi's sarcoma (KS) is a cancer that usually causes tumors to form in the tissues below the skin or face or in the mucous membranes of the nose, mouth, or anus. Patients typically suffer from lesions on the skin, which appear as raised blotches or lumps that may be purple, brown, or red. While the skin lesions may be disfiguring, they are not usually life threatening. In some cases, the lesions may be painful or cause swelling. However, if KS develops in the lungs, liver, or gastrointestinal tract, the disease may be life threatening because internal bleeding or difficulty breathing may develop. Patients should consult their healthcare providers if they experience symptoms of KS.
Stevens-Johnson syndrome: A skin rash and fever may be symptoms of a severe allergic reaction to medications, called Stevens-Johnson syndrome (SJS). This condition is potentially life threatening because, in severe cases, the lesions can cause significant scarring of the involved organs, which often leads to loss of function of the organ systems.
The reaction typically starts with a nonspecific upper respiratory tract infection. During the first stage of SJS, patients may experience flu-like symptoms, including, fever, sore throat, chills, headache, and a general feeling of discomfort for one to 14 days. Some patients also develop diarrhea and vomiting. As the disease progresses, skin lesions quickly develop. Skin lesions may occur anywhere, but they are most common on the soles of the feet, palms of the hands, and back of the hands. The skin may become red, swollen, or blistered and may contain open sores and/or blisters. Patients may experience extensive shedding of the skin.
Patients who experience symptoms of SJS should seek immediate medical treatment.