How is the rash of rubella differentiated from the rash that occurs with Epstein-Barr virus (EBV) infectious mononucleosis (mono)?

Updated: Sep 20, 2018
  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Rubella is the least likely exanthem to be confused with EBV mononucleosis; the rash persists longer and is not accompanied by the other features that are characteristic of infectious mononucleosis, eg, prominent pharyngitis. Patients with measles have conjunctival injection, coryza, and a rash that is maculopapular but blotchy and progresses from the head downward, differentiating it from the rash of EBV. A rash caused by contact dermatitis or drug-induced maculopapular rashes are pruritic, differentiating them easily from the rash of EBV. Erythrodermas with an initial presentation of maculopapular rashes caused by systemic disorders are usually persistent (eg, Sézary syndrome), in contrast to the evanescent mild rash of EBV infectious mononucleosis.

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