Clinical manifestation

May follow upper respiratory infection; associated with headache, nausea, vomiting, myalgias, and arthralgias; fulminant disease: hemorrhagic eruption, hypotension, and cardiac depression occur within hours of initial presentation; skin findings of petechiae on the extremities and trunk, sometimes generalizing; progression: pustules, bullae, and hemorrhagic plaques with central necrosis and stellate purpura with a central "gun-metal" gray hue; neurologic findings: headache; altered mental status; neck stiffness; irritability; seizures; nerve palsies; gait disturbance; gastrointestinal findings: nausea and vomiting

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