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Case 174

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A 9 months-old female patient presented with a history of fever in the previous 5 days (39,5ºC), that only last 3 days. Two days ago, a non-pruritus exanthema developed, beginning at the chest and progressing towards the face and the cervical area, as shown in the pictures.

Based on the clinical presentation and the dermatological findings, which one is the most likely diagnosis?

a) Rubella

25%

b) Erythema infectiosum

25%

c) Exanthema subitum

25%

d) Scarlet fever

25%
   

Image analysis

 

Morbiliform exanthema, composed by erythematous papules and macula in multiples sizes, irregular shapes and uncommitted skin nearby, seen in the face, scalpel and cervical area.

Relevant aspects

- The exanthema subitum is usualy caused by herpesvirus 6.

- Most affected patients are between 6 months and 3 years old, not marked by seasons.

- It is a clinical diagnosis, characterized by the classical picture of high fever during 3 to 5 days, followed by exanthema progressing from the chest to face and limbs.

- It is respiratory and orally transmitted, only after the incubation period (7 to 17 days), hence, before the developing of the exanthema.

- Differential diagnosis is made after other exanthemata conditions, meningitis, gastroenteritis, respiratory and urinary infections and drug related rash.

- It is a benign and self-limited condition, which treatment is only symptomatic.

References

- Freire HBM, Tonelli E, Freire LMS. A criança com exantema. In: Leão E, Corrêa EJ, Mota JAC, Vianna MB, Vasconcellos MC. Pediatria Ambulatorial. 5a ed. Belo Horizonte: Coopmed, 2013. p. 719-28.

- Kliegman RM, Stanton BF, Schor NF, Geme III JWS, Behrman RE. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier, 2011.

- Tremblay C, Brady MT. Roseola infantum (exantema subitum). Waltham: UpToDate, 2014. [accessed in September 2014]. Available at: http://www.uptodate.com/contents/roseola-infantum-exanthem-subitum

- Lopez FA, Sanders CV. Fever and rash in the immunocompetent patient. Waltham: UpToDate, 2014. [accessed in September 2014]. Available at: http://www.uptodate.com/contents/fever-and-rash-in-the-immunocompetent-patient

Author

Marina Bernardes Leão, 6th year medical student at UFMG.

E-mail: marinableao[at]hotmail.com

Supervisor

Márcia Gomes Penido Machado, professor of the Pediatrics Department at UFMG Medical School.

E-mail: mgpenido[at]gmail.com

Reviewers

André Guimarães, Amanda Oliveira, Carla Faraco, Barbara Queiroz, Luanna Monteiro and Viviane Parisotto

Translated by

Renato Gomes Campanati, 6th year medical student at UFMG. Email: campanati[at]ufmg.br.

 

 

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