The skin lesions of disseminated gonococcemia begin as tiny red papules and petechiae and then evolve into painful purpuric pustules and vesicles scattered on the distal extremities. Fever, polyarthritis, or monoarticular arthritis may be The rash of Rocky Mountain spotted fever appears between the second and sixth day of the illness, initially as small, erythematous macules that blanch on pressure but then evolving into petechiae, purpura, and ecchymoses. The rash first occurs on the acral areas and then spreads to the extremities and trunk. Small areas of necrosis may occur on the fingers, toes, and ear lobes. Fever, severe headache, toxicity, confusion, and myalgias commonly occur.
Infective endocarditis is associated with petechial and purpuric skin lesions.
Petechiae appear in crops in the conjunctivae, buccal mucosa, upper chest, and extremities.