Rubella Rash
A 23-year-old woman presented to the emergency department after 1 day of fever, sore throat, arthralgia, and rash. Diffuse erythema (Panel A) that blanched on pressure was noted over the face, neck, trunk, and arms, along with posterior cervical lymphadenopathy. The next day, the fever and rash subsided, but she reported pain in the oral cavity. Examination revealed petechial hemorrhages on the soft palate (Panel B) that disappeared spontaneously in 2 days. She had no history of rubella vaccination. Testing for rubella IgG antibody was negative, and testing for rubella IgM antibody was positive, which confirmed the clinical diagnosis of rubella. The number of rubella cases in Japan, especially in Tokyo, has been increasing in the past year. Approximately 70% of reported cases of rubella involve middle-aged men, partly because boys were not vaccinated against rubella by the national immunization program until 1995. To prevent the congenital rubella syndrome, the vaccination of women of childbearing age and their partners is currently a priority.
