A 9-month-old female presented with a 2-day history of fever up to 103 degrees Fahrenheit that improved with Tylenol. Yesterday a rash developed on her neck and trunk and spread to her upper extremities. On physical exam, she had a diffuse, non-pruritic, blanching, rose-colored papular rash on her neck, trunk, and proximal upper extremities. The diagnosis was roseola infantum (sixth disease), caused by human herpesvirus 6. It presents with a sudden high fever for 3-7 days followed by a sudden drop in fever and rash.
A 9-month-old female presented with a 2-day history of fever up to 103 degrees Fahrenheit that improved with Tylenol. Yesterday a rash developed on her neck and trunk and spread to her upper extremities. On physical exam, she had a diffuse, non-pruritic, blanching, rose-colored papular rash on her neck, trunk, and proximal upper extremities. The diagnosis was roseola infantum (sixth disease), caused by human herpesvirus 6. It presents with a sudden high fever for 3-7 days followed by a sudden drop in fever and rash.
A 9-month-old female presented with a 2-day history of fever up to 103 degrees Fahrenheit that improved with Tylenol. Yesterday a rash developed on her neck and trunk and spread to her upper extremities. On physical exam, she had a diffuse, non-pruritic, blanching, rose-colored papular rash on her neck, trunk, and proximal upper extremities. The diagnosis was roseola infantum (sixth disease), caused by human herpesvirus 6. It presents with a sudden high fever for 3-7 days followed by a sudden drop in fever and rash.
A 9-month-old female presented with a 2-day history of fever up to 103 degrees Fahrenheit that improved with Tylenol. Yesterday a rash developed on her neck and trunk and spread to her upper extremities. On physical exam, she had a diffuse, non-pruritic, blanching, rose-colored papular rash on her neck, trunk, and proximal upper extremities. The diagnosis was roseola infantum (sixth disease), caused by human herpesvirus 6. It presents with a sudden high fever for 3-7 days followed by a sudden drop in fever and rash.
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Case Study
Helen McDonald
CC: Body Rash
HPI: 9 month old female presents PCP with mother, 2 day Hx fever 103F, Tylenol 105 mg improved fever, yesterday no fever, rash began on neck, trunk, spread to upper extremities PMH: 39 week gestation, uncomplicated spontaneous vaginal delivery PSH: Denies
Meds: Tylenol 115mg q8hr PO PRN
Immunization: HepB, RV, DTaP, Hib, PCV, IVP, influenza 2015 Allergies: No known food/drug/dyes/latex allergies Social Hx: Resides with both parents, two older brothers, no second hand smoke exposure, bears weight, crawls, pincer gasp, uncovers hidden toy, says nonspecific mama, dada, understands no
Family Hx Denies family hx cardiovascular, lung diseases, DM, Stroke, cancer Father 26 AW, Mother 26 AW, PGF 46 AW, PGM 46 AW, MGF 49 AW, MGM 48 AW, Brothers 5 & 2 both AW
ROS General: Fever 103 x 2 days, listless, irritability Head: Denies HA, head injury Eyes: Denies infection, drainage Ears: Denies ear tugging, rubbing Mouth/throat: Denies ulceration, odor, excessive salivation or dryness Neck: Denies lumps, decreased ROM
ROS continued Nose: Denies rhinorrhea, seasonal/environmental allergies, hay fever Derm: Red, bumpy rash, began yesterday on neck and trunk, spread to upper extremities. Denies changes in soap, lotions, detergents Resp: Denies wheezing, cough Cardiac: Denies heart murmurs GI/GU: Denies change in appetite, diarrhea, strong urine smell
Physical Exam General: Nontoxic, well developed, calm, 9 month old, clinging to mother VS: T: 98.7, P: 90, RR: 30, Wt: 7.7 kg, ht: 27.5 Head: Normocephalic, Anterior fontanel nonbulging, posterior fontanel closed Eyes: No drainage, redness Ears: Auditory canals clear, no erythema, TM clear with light reflex bil
Mouth/throat: No ulcerations, erythema,
exudate, tonsils 1+ Neck: No adenopathy Nose: Patent, clear bil Derm: Neck, trunk, proximal BUE with diffuse, nonpruritic, blanching, rose-colored papules, 2-3mm in diameter Resp: Breath sounds bilaterally clear CV: Regular rate, rhythm, no murmurs, S1&S2 intact
Whats the Diagnosis
Differential Dx
ICD10-D B34.1 Enterovirus infection, unspecified
ICD10-D B08.3 Fifth disease ICD10-D B06.9 Rubella without complication ICD10-D B05.9 Measles without complication ICD10-D O34.1 Scarlet fever ICD10-D A41.9 Sepsis, unspecified organism ICD10-D L27.0 Generalized skin eruption due to drugs and medication taken internally
Etiology Human Herpesvirus 6 Infection (HHV-6) Communicable DNA virus
Transmission via oral, nasal, conjunctival routes, possibly perinatal
Prevalence Between 7-13 months
Clinical findings
Sudden onset fever 101 to >103F for 3-7D
No apparent cause Followed by sudden drop in fever then skin rash Anorexia, irritability, URI S/S, or no ill findings Inflammation of TM Cervical/posterior auricular adenopathy Fever related seizures
Rash
Nonpruritic Maculopapular Blanching Slight elevation Rose-pink papules Appears first on neck/trunk then arms Appears more mildly on face/legs Fades within a few hours to two days
Diagnostics Clinically diagnosed R/O cause of infection if concerned about patient condition Labs CBC, UA, Blood culture, IgM, IgG CXR
Reassurance Permanent immunity with one illness Self-limiting Return to PCP if no symptom improvement within 1-2 days
Questions
References Domino, F. J., Baldor, R. A., Golding, J., Grimes, J. A., & Taylor, J. S. (2013). The 5-minute clinical consult 2013. Philladelphia, PA: Lipplincott Burns, E., Dunn, A., Brady, M., Starr, N. B., & Blosser, C. (2013). Pediatric primary care. Philladelphia, PA: Elsevier
