Context: Many diseases caused by viral agents are associated with fever and cutaneous manifestations. Viral exanthema is a widespread nonspecific skin rash, commonly characterized by generalized eruption of erythematous macules and papular lesions. Although these rashes are mostly benign and self-limited, some may be serious and life-threatening. Differentiation between severe and benign types is clinically important and life-saving.
Evidence Acquisition: In this narrative review, electronic databases, including Google Scholar, Science Direct, PubMed (including Medline), Web of Science, Scientific Information Database, and Scopus, were searched. We conducted a narrative review of papers published on pediatric viral exanthema during 2000 - 2016. The used keywords included “viral exanthema”, “fever”, and “skin rash”. Articles on skin rash, caused by drug reactions or nonviral exanthema, were excluded.
Different viral agents can cause different types of skin reactions. Cutaneous manifestations and skin rashes can be categorized, based on the form of the rash (macular, papular, vesicular, blistery, petechial, and purpuric) or the general term, which denotes illnesses such as measles-like morbilliform rash, rubella or rubelliform rash, and scarlatiniform rash, a scarlet-fever like infection.
Based on the findings, a systematic approach relying on accurate history-taking and analysis of epidemiological cues and rash characteristics is of great significance.

Hyperpigmentation over face in a neonate is rare and the differentials for the same are also rare. Congenital chikungunya, fungal and viral infections, drug rash are few differentials. Chikungunya Virus (CHIKV) infection manifesting in neonates is very rare. The prevalence of the entity was described only recently. We describe a neonate with hyperpigmentation on day 3 of life with stormy course thereafter. The distinguishing rash on face helped us in clinching the diagnosis of congenital chikungunya and fungal sepsis. Identification of this entity was based on characteristic skin rash and epidemiological background.

Measles is a highly contagious viral disease, which affects mostly children and rarely adults, which results in a more severe presentation. After a prodromal phase (malaise, anorexia, and the classic triad of conjunctivitis, cough, and coryza and a high fever), enanthem (Koplik spot) appears at buccal mucosa and then, typical erythematous maculopapular rash happens. There are several reports of atypical measles in the adults who have been immunized by killed type vaccine, therefore, prior history of vaccination with the original killed - virus among individuals who present with maculopapular rash and fever do not rule out measles.
Here we report a 44 - year - old woman with fever, chills, myalgia, odynophagia, exudative pharyngitis, bilateral parotitis, anterior cervical lymphadenopathy, tender splenomegaly, conjunctival suffusion and disseminated pruritic erythematous maculopapular, as well as a petechial rash all over her body. She was evaluated mainly for infectious mononucleosis, acute human immunodeficiency virus infection, and acute viral hepatitis, when all investigations were negative for possible diagnoses, although she mentioned immunization against measles, evaluations for measles were done and she had positive IgM antibody with high titer and also positive measles virus RT - PCR.
The aim of this report is to emphasize that physicians should be aware of the atypical measles syndrome and entertain the diagnosis of measles in adults with a febrile illness and rash in order to make the most accurate diagnosis and prevent complications.

Cutaneous eruptions and arthralgia in children can occur after infections, drugs and immunologic processes via different mechanisms. This is a report of a 7 years old girl with a history of maculopapular rashes that changed to target-shaped lesions and pruritus with non-pitting edema of ankles, strawberry tongue and periungual scaling of extremities, with no history of any drug usage. She had elevated liver enzymes and positive anti-viral capsid antigen (VCA) (IgM and IgG), and depressed C3, C4 and CH50, that returned to normal after 3 months. Here we explain the states that could cause similar clinical scenario and discuss them briefly.

Coronavirus Disease 2019 was initially identified as an infection of the lower respiratory tract but has so far manifested itself with very different symptoms. One of these symptoms is skin lesions associated with an active viral infection that can occur from the onset of infection until treatment. Therefore, observing these skin manifestations can be helpful in diagnosing and managing the disease. Our case is a 56-year-old man who came to the infectious clinic with a chief complaint of skin rashes. The patient was in good general condition on arrival and had no evidence of systemic symptoms of infection, such as fever, body aches, and cough. However, the PCR test for COVID-19 was positive. Although many dermatological findings have been reported with Coronavirus Disease, this case has reported with no symptoms other than skin manifestations that describe a viral infection. It seems that this disease can cause unexpected symptoms, even in mild cases. Therefore, it is better to have the COVID-19 in the corner of your mind when examining people with these symptoms.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a complex and potentially fatal hypersensitivity condition. We present a unique case report and literature review focusing on DRESS syndrome-associated myocarditis resulting from reactivated viral infections in a 21-year-old female. 3 weeks after 5-day oral co-trimoxazole consumption due to acne, she developed symptoms consistent with DRESS syndrome, including a generalized maculopapular rash. Despite prednisolone treatment, the patient developed fatal fulminant myocarditis linked to HHV-6 and CMV reactivation. The patient's death highlights the importance of early recognition and careful management of DRESS syndrome, especially considering the potential viral reactivation that can lead to severe complications. Postmortem investigations revealed that viral reactivation caused myocarditis. Careful consideration must be given to corticosteroid usage in DRESS treatment, as inappropriate prescribing may promote viral reactivation and subsequent complications. While high-dose corticosteroids initiated within the first week effectively suppress HHV-6 reactivation. Conversely, low-dose or late-start high-dose corticosteroids prove ineffective in preventing HHV-6 viremia. Late- onset or low- dose corticosteroids may lead to fatal complications following the primary viral reactivation.

Rash is a common complaint in children that has many causes and the various differential diagnoses. Therefore, urgent and appropriate clinical diagnosis is necessary to provide immediate medical intervention. Therefore, the purpose of this study was to investigate the causes of skin rash in children hospitalized due to rash.
This descriptive-analytic study was performed on all patients admitted for skin rashes in Hazrat Masoumeh Hospital in Qom, Iran from 2010 to 2015. In this study, the data of 317 patients who were admitted to the early diagnosis of rash were collected from patient's files and recorded in the checklist.
According to our study, the most common causes of skin rashes in children were viruses with a share of 40.69% (129 cases), allergic causes being as prevalent as 21.77% (69 cases) and drug induced rashes that accounted for 20.50% (65 cases). Based on the site and type of rashes, the most common type of rashes were maculopapular rashes with 42% and hives with 31.9% prevalence, and the most common site of involvement was diffuse involvement that would account for 84% of the cases. In terms of drug use history, 35.6% had a history of antibiotic use prior to admission, and 14.5% had an antiepileptic drug use history. There was a significant relationship between the cause of rashes and the season of presentation (P This study showed that there is a significant relationship between the season and age of occurrence, but the use of these factors as a benchmark for the diagnosis of rash requires more studies. Paying attention to the causes of rash in children, knowing about these factors, and continuous evaluation of these patients can help in advancing a proper management of the problem of patients. The most frequent factors were viruses and then allergic and pharmaceutical agents, and the most common type was maculopapular.

Measles is a contagious respiratory viral infection that accompanied with skin rash. Vaccination against measles has reduced the prevalence of the disease but sporadic measles epidemic still occurred in young people. This study, was carried out for the response evaluation of immunity against measles in Iranian soldiers living in garrisons. In this study based on the history of measles, contact with measles cases, measles in the family and vaccination, 360 sera samples were obtained from male soldiers living in Tehran during years of 2003-2004 using ELISA method. Whereas, 48.9% and 22.5% of cases were negative for IgG and IgM respectively, 22.5% of the samples were seronegative for both IgG and IgM isotypes. The respective antibody titers of IgG and IgM were 14.45% and 36.56%. Regarding 22.5% negative cases for IgG isotype and 36.67% of positive IgM is indicative of possible latest outbreak. Single vaccination against measles during childhood was not protective and requires booster injections.

Herpes zoster Infection (HZI) is a viral disease with painful skin rashes and blisters in a limited area on one side of the body, often in a strip. Osteonecrosis with spontaneous exfoliation of teeth in association with HZI of the mandibular nerve is a rare phenomenon. In this report, such an unusual complication of HZI is presented.
Case Report:The clinical course of a 53-year-old woman and a 54-year-old man with HZI associated with alveolar bone necrosis and tooth exfoliation were reviewed in order to develop a patient profile for this rare combination of physical findings.
In immunocompromised patients, the clinicians should consider HZI as a possible cause of tooth mobility, exfoliation, and alveolar osteonecrosis, which needs early intervention to prevent secondary complications.

While the world is still trying to emerge from the crisis due to the COVID-19 pandemic, and all the nations are trying to nullify the repercussions caused by it; another outbreak known as the monkeypox virus (MPXV) has recommenced. Human monkeypox, a rare viral zoonosis (an infectious disease that can be transferred from non-human animals to humans), is caused by the MPXV, a member of the genus Orthopoxvirus (family Poxviridae, subfamily Chordopoxvirinae). Since eradicating smallpox globally in 1977, monkeypox has been the primary orthopoxvirus infection in humans. On July 14, 2022, the first case in India was reported in the Kollam district of Kerala. It manifests with the same symptoms as smallpox, including flu-like symptoms, fever, malaise, headache, back pain, and a characteristic rash. New medications have shown promising results, but more study is needed for the drug’s efficacy in endemic settings. The monkeypox virus is a high-danger pathogen that causes a significant disease for public health. Consequently, there is a pressing need to develop surveillance capabilities that can yield valuable data for creating suitable preventative, preparedness, and response operations.