Erythema infectiosum in Child
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.
B08.3 – Erythema infectiosum [fifth disease]
34730008 – Erythema infectiosum
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 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.