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Updated: Dec 25 2021

Roseola Infantum

Images rash formatted.jpg
  • Snapshot
    • A 9-month old girl presents to the pediatrician for a rash on her trunk. She had a high-grade fever for 3 days, and she has been receiving ibuprofen for the fever. She has been more irritable but has been eating and having sufficient diapers. This morning, she no longer had a fever but developed a pink rash over her chest and back. On physical exam, there is a blanching, light pink rash with macules and papules on the trunk and back. She also has erythematous papules on her soft palate. Her mother is reassured that this disease is self-limited and has no complications.
  • Introduction
    • Classification
      • human herpesvirus-6 (HHV-6)
        • an enveloped, linear, double-stranded DNA virus
        • a picornavirus and enterovirus
        • transmission via respiratory secretions
        • causes roseola infantum (exanthem subitum)
    • Prevention
      • no vaccines are available
  • Epidemiology
    • Demographics
      • infants > children > adults
    • Location
      • skin
    • Risk factors
      • immunosuppression
      • transplant recipients
    • Pathogenesis
      • the virus replicates in salivary glands
      • the virus is latent in lymphocytes and monocytes
      • may contribute to tumor progression in Kaposi sarcoma and lymphoma
    • Associated conditions
      • may be associated with human herpesvirus-7
  • Presentation
    • Symptoms
      • high fever for 3 days
      • may have febrile seizures
      • no upper respiratory symptoms
      • temporally separated by rash
    • Physical exam
      • light pink, morbilliform rash that develops after the fever resolves
        • blanching
        • discrete, irregular macules and papules
        • lasts 2 days
      • Nagayama spots
        • erythematous papules on the mucosa of soft palate and uvula
  • Differential
    • Measles
      • distinguishing factor
        • cough, conjunctivitis, coryza, Koplik spots, and confluent rash excluding palms and soles
    • Rubella
      • distinguishing factor
        • postauricular lymphadenopathy with non-confluent rash that desquamates
    • Making the diagnosis
      • based on clinical presentation
  • Treatment
    • Management approach
      • mainstay of treatment is supportive care
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • antipyretics
          • hydration
  • Complications
    • Seizures
  • Prognosis
    • Does not commonly recur
    • Disease is self-limited
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