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 ETIOLOGY 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 DIAGNOSIS 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