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Erythema infectiosum - Skin
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Erythema infectiosum - Skin

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Contributors: Sarah Stein MD, Karen Wiss MD, Sheila Galbraith MD, Craig N. Burkhart MD, Dean Morrell MD, Lynn Garfunkel MD, Nancy Esterly MD
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Synopsis

Erythema infectiosum, or fifth disease, is a common illness in young children due to infection with parvovirus B19. Infection can result in a mild exanthem, no exanthem, or the typical "slapped cheeks" rash.

Children may have a prodromal headache with associated low-grade fever and rhinorrhea beginning 2 days before the onset of the rash. Children recover spontaneously without therapy.

Codes

ICD10CM:
B08.3 – Erythema infectiosum [fifth disease]

SNOMEDCT:
34730008 – Erythema infectiosum

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Differential Diagnosis & Pitfalls

  • Scarlet fever – Typically begins on the neck and trunk, then later involves the extremities. Patients also display signs and symptoms of streptococcal pharyngitis.
  • Erysipelas of the face – An acute beta-hemolytic group A streptococcal infection of the skin involving the superficial dermal lymphatics. Skin lesions have a distinctive raised, sharply demarcated advancing edge.
  • Cellulitis – Almost always unilateral
  • Contact dermatitis – Usually is pruritic and asymmetric
  • Kawasaki's disease – Fever, foot and hand edema, conjunctival injection, lymphadenopathy, and genital area erythema. Kawasaki disease can present with red cheeks, as does fifth disease. Premature closure on fifth disease leading to missing Kawasaki disease is a diagnostic pitfall.
  • Tinea faciei
  • Rubella – Starts on the face and progresses caudad, covering the entire body in one day and resolving by the third day. Red macules or petechiae may be seen on the soft palate and uvula (Forchheimer's sign).
  • Roseola infantum – Three days of high fever followed by the appearance of a morbilliform erythema upon defervescence consisting of rose-colored macules on the neck, trunk, and buttocks. Mucous membranes are spared.
  • Rubeola (measles) – Is marked by the appearance of morbilliform lesions on the scalp and behind the ears that spreads to involve the trunk and extremities over 2-3 days. Koplik spots are pathognomonic and appear during the prodromal phase.
  • A careful history should help distinguish from a potential drug eruption.

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Last Updated: 06/05/2013
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Erythema infectiosum - Skin
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Erythema infectiosum (Prodromal Stage) : Headache, Rhinorrhea, Low grade fever
Clinical image of Erythema infectiosum
Erythematous patches on the cheeks giving rise to the "slapped cheek" appearance.
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