DDx
Diagnostic Considerations
Other problems to be considered include the following:
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Acute leukemia
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Allergic dermatitis
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Bullous pemphigoid
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Chickenpox
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Disseminated herpes zoster
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Disseminated herpes simplex
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Drug reactions
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Drug eruptions
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Eczema vaccinatum
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Ehrlichiosis
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Erythema multiforme major (including Stevens-Johnson syndrome)
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Gram-negative septicemia
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Hand-foot-and-mouth disease
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Meningococcemia
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Measles
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Monkeypox (endemic in some areas of Africa) [7]
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Hemorrhagic varicella
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Rocky Mountain spotted fever
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Secondary syphilis
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Vaccinia
Differential Diagnoses
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Eczema vaccinatum
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Scabies
Media Gallery
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Characteristic skin lesion of variola on the arms and legs of an adolescent. Photo used with permission from the World Health Organization (WHO).
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Small child with pustular lesions of variola. Photo used with permission of the World Health Organization (WHO).
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Infant with advanced lesions of variola. Photo used with permission of the World Health Organization (WHO).
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Unvaccinated infant with centrifugally distributed umbilicated pustules on day 3 of ordinary form of variola major strains of smallpox. Reprinted with permission from Fenner F, Henderson DA, Arita I, et al: Smallpox and its eradication. Geneva, Switzerland: World Health Organization; 1988: 10-14, 35-36; photographs by Arita.
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Unvaccinated infant with centrifugally distributed umbilicated pustules on day 5 of ordinary form of variola major strains of smallpox. Reprinted with permission from Fenner F, Henderson DA, Arita I, et al: Smallpox and its eradication. Geneva, Switzerland: World Health Organization; 1988: 10-14, 35-36; photographs by Arita.
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Unvaccinated infant with centrifugally distributed umbilicated pustules on day 7 of ordinary form of variola major strains of smallpox. Reprinted with permission from Fenner F, Henderson DA, Arita I, et al: Smallpox and its eradication. Geneva, Switzerland: World Health Organization; 1988: 10-14, 35-36; photographs by Arita.
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Ordinary form of variola minor strain of smallpox (alastrim) in an unvaccinated woman 12 days after onset of skin lesions. The facial lesions are sparser and evolved more rapidly than the extremity lesions. Reprinted with permission from Fenner F, Henderson DA, Arita I, et al: Smallpox and its eradication. Geneva, Switzerland: World Health Organization; 1988: 10-14, 35-36; photographs by Arita.
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Ordinary form of variola minor strain of smallpox (alastrim) in an unvaccinated woman 12 days after onset of skin lesions. The facial lesions are sparser and evolved more rapidly than the extremity lesions. Reprinted with permission from Fenner F, Henderson DA, Arita I, et al: Smallpox and its eradication. Geneva, Switzerland: World Health Organization; 1988: 10-14, 35-36; photographs by Arita.
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Ordinary form of variola minor strain of smallpox (alastrim) in an unvaccinated woman 12 days after onset of skin lesions. The facial lesions are sparser and evolved more rapidly than the extremity lesions. Reprinted with permission from Fenner F, Henderson DA, Arita I, et al: Smallpox and its eradication. Geneva, Switzerland: World Health Organization; 1988: 10-14, 35-36; photographs by Arita.
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Adult with variola major with hundreds of pustular lesions distributed centrifugally. Fitzsimmons Army Medical Center slide file.
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Hemorrhagic-type variola major lesions. Death usually ensued before typical pustules developed. Reprinted with permission from Herrlich A, Mayr A, Munz E, et al: Die pocken; Erreger, Epidemiologic und klinisches Bild. 2nd ed. Stuttgart, Germany: Thieme; 1967. In: Fenner F, Henderson DA, Arita I, et al: Smallpox and its eradication. Geneva, Switzerland: World Health Organization; 1988: 10-14, 35-36.
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Boy with monkeypox in Democratic Republic of the Congo in 1996. Note the centrifugal distribution as was typical of smallpox. Courtesy of William Clemm.
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Boy with monkeypox in Democratic Republic of the Congo in 1996. Note synchronicity of lesions as was typical of smallpox. Courtesy of William Clemm.
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