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treatment of choice.
Mycoplasma can also induce Stevens–Johnson syndrome (see Chapter 68
Rash: Drug Eruptions ). The rash here is characterized by hemorrhagic lips and
mucosal involvement with fewer bullous lesions on the rest of the skin and is thus
sometimes referred to as Mycoplasma pneumoniae-associated mucositis.
Roseola Infantum
Roseola infantum, also called exanthem subitum or sixth disease , is attributed to
primary infection with human herpes virus (HHV)-6. The illness is characterized
by the onset of a maculopapular rash that appears following a 3- to 4-day febrile
illness. The fever is characteristically high. The rash is widely disseminated,
appearing as discrete, small, pinkish macules that rarely coalesce, beginning on
the trunk and then extending peripherally. The rash may last for hours to days.
The occurrence of the rash within 24 hours of defervescence rather than the
morphologic appearance of the rash itself leads to the correct diagnosis. The rash
can appear very similar to that seen in measles, but the child with roseola appears
well and is no longer febrile. Diagnosis is made clinically and care is supportive.
Disseminated Neisseria Gonorrhoeae
Disseminated Neisseria gonorrhoeae should be considered in sexually active or
potentially abused children, especially if associated with a history of vaginal or
penile discharge. A distinct minority of patients develop disseminated gonorrhea
infection through hematogenous spread. Disseminated gonorrhea may cause a
range of cutaneous lesions, including small erythematous papules, petechiae, or
vesicle-pustules on a hemorrhagic base. These cutaneous lesions usually develop
on the trunk but may occur anywhere on the extremities.
An etiologic diagnosis can be established by demonstration of the organism on
Gram stain of the skin lesion, positive blood culture, or positive culture of oral or
genital sites. Based on resistance patterns, recommended current therapy is
ceftriaxone 50 mg/kg/day (maximum 1 g/day) until clinical improvement is seen,
at which point it can be changed to an oral antibiotic, such as cefixime,
ciprofloxacin, ofloxacin, or levofloxacin, for a total of a 7-day course. Quinolones
should not be used for infections in men who have intercourse with men or in

those with a history of recent foreign travel or partners’ travel, or infections
acquired in other areas with increased resistance. Concomitant sexually
transmitted diseases should be sought and treated.
Secondary Syphilis