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Reassure parent that the rash is self-limiting
67%
14/21
Red blood cell transfusion
24%
5/21
Monoclonal antibody against tumor necrosis factor-alpha
0%
0/21
Guanosine analog that leads to viral DNA polymerase inhibition
Vitamin A administration
10%
2/21
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The patient’s “slapped cheek” appearance is suggestive of erythema infectiosum (EI), also known as “fifth disease.” EI is caused by parvovirus B19 (PV19), an non-encapsulated single-stranded linear DNA virus. EI is benign skin rash that commonly presents with a mild fever. Nonspecific prodromal symptoms correspond with viremia. These symptoms include: low-grade fever, headache, nausea, coryza, and diarrhea. 48-72 hours later, the “slapped cheek” malar rash appears, followed by a lacelike rash found on the trunk and extremities. Joint pain and/or arthritis is more typical in adults. It is important to note that PVB19 can cause transient aplastic crisis in patients with blood diseases (i.e., sickle cell disease). Infections to the fetus can cause non-immune hydrops fetalis or intrauterine demise. Servey et al. state that a clinical diagnosis can be made if EI is present. However, if laboratory testing is needed, B19 specific antibody testing and viral DNA testing can be performed. Serum IgM testing in immunocompetent patients is recommended to diagnose acute viral infection due to its high sensitivity and specificity (89 and 99%, respectively). EI does not require treatment because it is self-limiting. Broliden et al. discuss the clinical aspects of PVB19 infection. PVB19 infection is associated with EI, arthropathy, and the onset of many autoimmune disorders, such as systemic lupus erythematosus. Patients that have an increased red cell turnover are susceptible to transient aplastic crises with this infection secondary to bone marrow (BM) suppression. In the immunocompromised, BM suppression can be persistent, resulting in chronic anemia. Figure A shows the “slapped cheek” appearance seen in erythema infectiosum. Note the perioral sparing. Illustration A shows a child with a reticulated malar rash located on his trunk and extremities Incorrect Answers: Answer 2: Blood transfusions would be indicated in transient aplastic crisis. Answer 3: Infliximab is a monoclonal antibody against tumor necrosis factor-alpha. This medication is used in conditions such as rheumatoid arthritis and psoriasis. Answer 4: Acyclovir, valacyclovir, and famciclovir are guanosine analogs which inhibit viral DNA polymerase. These medications are used for herpes simplex and varicella-zoster viral infections. Answer 5: Vitamin A administration is recommended for patients with measles infection.
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