The patient is an 18-month-old child who presents for evaluation of a rash affecting both cheeks. The onset was sudden and not preceded by trauma or exposure to excessive heat. The child is afebrile and in no acute distress. He received a brief course of amoxicillin approximately 4 weeks ago for a respiratory illness. Examination revealed well-demarcated zones of erythema, accompanied by occasional papules, on both cheeks. No other rash was noted elsewhere, and lymph nodes were nonpalpable.
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Slapped cheek syndrome, also known as fifth disease or erythema infectiosum, is a childhood illness that is caused by parvovirus B19 infection.1 Parvovirus B19 infections have a wide range of clinical manifestations, including skin and joint symptoms, as well as hematologic effects. Slapped cheek syndrome is the most common manifestation of parvovirus B19.2
Slapped cheek syndrome presents as a maculopapular, blotchy and lacy rash on the cheeks that is similar to a slapped cheek. The rash may extend to the extremities and trunk. Cases of this infection occur mostly in the winter and spring seasons.3 Diagnosis of the infection can be confirmed with serologic testing; however, the diagnosis is usually made clinically. Children with slapped cheek syndrome generally have a good prognosis, as the disease is self-limited. Treatment strategies include supportive care and analgesics.4 Pregnant women who contract parvovirus B19 during the first trimester are at heightened risk for miscarriage.
John Pappas is a medical student at Geisinger Commonwealth Medical College, and Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
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- Valentin MN, Cohen PJ. Pediatric parvovirus B19: spectrum of clinical manifestations. Cutis. 2013;92:179-184.
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- Kirchner JT. Erythema infectiosum and other parvovirus B19 infections. Am Fam Physician. 1994;50:335-341.