A 6 year old male child presented with fever with chills and rigor along
with vomiting and rash over the face. On examination a erythematous rash
was present on face involving cheeks and nose and sparing the lower face (Fig.
1). Rash had spared the trunk and extremties and hepatosplenomegaly
was also present. Clinically measles, rubella, drug reaction and some
connective tissue diseases present with these features. In measles and
rubella, rashes are maculopapular, spread to involve trunk and extremity
including palm and soles and commonly they are associated with high grade
fever. In drug reaction there is history of drug exposure and moderate to
severe degree of itching is associated with rashes which are discrete. In
connective tissue disorder onset of rashes is insidious, restricted to
face only and often involve mucous membrane. The rashes are photosensitive
and are associated with arthropathy. We made a clinical diagnosis of
Erythema infectiosum. Parvovirus B19–IgM assay was positive (50 U/mL).
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Fig. 1 Erythema Infectiosum rash. |
Erythema infectiosum also known as Fifth disease is
caused by parvovirus B19 infection. This is a benign, self limited
exanthematous illness of childhood. A mild prodome is followed by the
characteristic rash which occurs in three stages. It starts with
erythematous facial flushing, often described as a "slapped cheek
appearance". The rash spreads to involve trunk as diffuse macular erythema
in second stage which is followed by central clearing of the macular
lesion giving the rash a lacy reticulated appearances. Diagnosis is
usually clinical but can be confirmed by B19-IgM assay in acute phase or
PCR for viral DNA in immunocompromised patients. This disease is benign
and there is no specific antiviral therapy.
