Erythema infectiosum

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  • Also known as "Fifth disease"
  • Caused by Parvovirus B19
    • Infection in pregnancy can → Hydrops fetalis, fetal anemia, and fetal loss
    • May precipitate aplastic crisis in patients with sickle cell disease

Clinical Features

  • Initially mild URI-type symptoms
  • "Slapped cheeks" rash
    • Abrupt appearance on day 3-4
      • Spares eyelids and chin
    • Lasts 4-5 days
  • Macular erythema develops on trunk/limbs 2 days after appearance of facial rash
    • distinctive aspect of rash: faces with central clearing, giving a reticulated or lacy appearance
    • May last 1 week
    • Rash may recur within 3 week period
  • Papulopurpuric glove-and-sock syndrome
    • pruritic or painful petechiae/purpura limited to the hands and feet. [1]
  • Associated symptoms include fever, headache, sore throat, cough, coryza, nausea and vomiting
Fifths Disease

Differential Diagnosis

Pediatric Rash


  • Clinical diagnosis, based on history and physical exam


  • Symptomatic


  • Discharge
  • (Admit if aplastic crisis)
  • Referral to maternal-fetal medicine specialist for infection in pregnancy


See Also


  1. Shirk A, Sorrentino A. Viral Exanthems. In: Schafermeyer R, Tenenbein M, Macias CG, Sharieff GQ, Yamamoto LG. eds. Strange and Schafermeyer's Pediatric Emergency Medicine, 4e. New York, NY: McGraw-Hill; 2015