A generalized petechial eruption that involves the entire cutaneous surface, including the palms and the soles but characteristically appears first on the wrist and ankles.

Pinpoint palmar purpura of Rocky Mountain spotted fever.

Rocky Mountain spotted fever is caused by an obligate intracellular coccobacillus R. rickettsi. It is transmitted by the bite of an infected Dermacentor or Ixodes tick.