Erythema infectiosum

Background

• Also known as "Fifth disease"
• Caused by Parvovirus B19
  • Infection in pregnancy can → Hydrops fetalis, fetal anemia, and fetal loss
  • May precipitate aplastic crisis in patients with sickle cell disease

Clinical Features

• Initially mild URI-type symptoms
  • Malaise, myalgias, and headache 7-10 days prior to rash
• "Slapped cheeks" rash
  • Abrupt appearance on day 3-4
    • Spares eyelids and chin
  • Lasts 4-5 days
• Macular erythema develops on trunk/limbs 2 days after appearance of facial rash
  • Distinctive aspect of rash: faces with central clearing, giving a reticulated or lacy appearance
  • May last 1 week
  • Rash may recur within 3 week period
• Papulopurpuric glove-and-sock syndrome
  • Pruritic or painful petechiae/purpura limited to the hands and feet.
• Associated symptoms include fever, headache, sore throat, cough, coryza, nausea and vomiting

Fifths Disease

Differential Diagnosis

Pediatric Rash

• Atopic dermatitis
• Bed bugs
• Contact dermatitis
• Drug rash
• Erythema infectiosum (Fifth disease)
• Hand-foot-and-mouth disease
• Henoch-schonlein purpura (HSP)
• Herpangina
• Herpes simplex virus (HSV)
• Infectious mononucleosis
• Meningitis
• Measles
• Molluscum contagiosum
• Roseola infantum
• Rubella (German measles)
• Scabies
• Scarlet fever
• Smallpox
• Varicella (Chickenpox)

Evaluation

• Clinical diagnosis, based on history and physical exam

Management

• Symptomatic

Disposition

• Discharge most patients
  • Referral to maternal-fetal medicine specialist for infection in pregnancy
• Admit if aplastic crisis

Complications

• Symmetric Polyarthropathy
• Myocarditis
• Pericarditis
• Glomerulonephritis
• Focal Glomerulosclerosis

See Also

• Pediatric Rashes