• Skin lesion or rash
• Brownish-red or copper-colored papule that is flat-topped and firm
• Rash that may appear as a linear string of >papules
• Generally not itchy
• Symmetrical distribution (looks the same on both sides of the body)
• Rash may appear on the palms and soles

Other symptoms that may appear include:

• Enlarged abdomen (because the liver and spleen can become enlarged)
• Enlarged lymph nodes
• Tender lymph nodes

Physical examination confirms the appearance of the rash. The liver and spleen may be enlarged (hepatosplenomegaly). The lymph nodes may be enlarged or tender (lymphadenopathy).

Tests that may be performed to confirm the diagnosis and to diagnose associated diseases include:

• Skin biopsy
• Liver enzymes (liver function tests)
• Hepatitis virus serology or Hepatitis B surface antigen
• Screening for EBV antibodies
• Bilirubin level