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Fever and rash in immunocompromised patients without HIV infection

Fred A Lopez, MD
Charles V Sanders, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD


At least 20 percent of immunocompromised hosts will develop skin lesions, frequently accompanied by fever [1,2]. Immunocompromising diseases can cause multiple defects in host defenses, which, in turn, lead to heightened susceptibility to various types of infections. Knowledge of these immune defects and the specific associated infections can assist the clinician in the initial evaluation and management of the immunocompromised patient with skin lesions. These lesions sometimes reflect disseminated infection; evaluation of the skin may provide the most rapid diagnosis and thus may be lifesaving.

Some of the common infectious agents and dermatologic manifestations observed in selected immunodeficient states will be reviewed here. Fever and rash in immunocompetent patients and HIV-infected individuals are discussed separately. (See "Fever and rash in the immunocompetent patient" and "Fever and rash in HIV-infected patients".)


Underlying diseases that affect various host defenses may predispose the patient to different types of infections. This section provides a brief overview of the different categories of immunocompromise and the types of pathogens that are most likely to affect patients in each category. It is not intended to provide comprehensive details on the immunology of each condition or an exhaustive list of infections that each type of host might experience. Following this overview of immunocompromising conditions, pathogens that most frequently cause fever and rash in immunocompromised hosts will be discussed.

Neutropenia or neutrophil dysfunction — Patients with prolonged or profound neutropenia or neutrophil dysfunction are at increased risk for developing infections with a variety of organisms, including gram-positive, gram-negative, and anaerobic bacteria, as well as fungi.

The most common cause of neutropenia is the administration of chemotherapeutic agents to patients with cancer. However, a number of other conditions also lead to neutrophil depletion or dysfunction, including acute myeloproliferative disorders, myelodysplastic syndromes, aplastic anemia, congenital or cyclic neutropenia, overwhelming sepsis, Felty's syndrome, or receipt of certain other drugs including azathioprine, mycophenolate mofetil, and ganciclovir.


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Literature review current through: Sep 2016. | This topic last updated: Mar 31, 2016.
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