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Images rash.jpg
  • Snapshot
    • A 6-month old boy born at full term to a 26-year-old mother is brought to the emergency room for high fevers and seizure lasting less than 1 minute. The mother reports that he has been healthy without any medical problems and has met all 6-month milestones. Two days ago, he began having high fevers and some irritability, and today, he had a seizure. He was admitted for infectious workup. The next day, his fever resolved and he developed a morbilliform blanching rash on his trunk.
  • Introduction
    • Classification
      • human herpesvirus-6 (HHV-6)
        • an enveloped, linear, double-stranded DNA virus
        • transmission via respiratory secretions
        • causes roseola infantum (exanthem subitum)
    • Epidemiology
      • demographics
        • infants > children > adults
      • location
        • skin
      • risk factors
        • immunosuppression
        • transplant recipients
    • Pathogenesis
      • the virus replicates in salivary glands
      • the virus is latent in lymphocytes and monocytes
      • may contribute to tumor progression in Kaposi sarcoma and lymphoma
    • Associated conditions
      • may be associated with human herpesvirus-7
    • Prevention
      • no vaccines are available
    • Prognosis
      • does not commonly recur
      • disease is self-limited
  • Presentation
    • Symptoms
      • high fever for 3 days
      • may have febrile seizures
      • no upper respiratory symptoms
    • Physical exam
      • light pink morbilliform rash that develops after the fever resolves
        • blanching
        • discrete and irregular macules and papules
        • lasts 2 days
      • Nagayama spots
        • erythematous papules on the mucosa of soft palate and uvula
  • Studies
    • Making the diagnosis
      • based on clinical presentation
  • Differential
    • Measles
      • distinguishing factor
        • cough, conjunctivitis, coryza, Koplik spots, and confluent rash excluding palms and soles
    • Rubella
      • distinguishing factor
        • post-auricular lymphadenopathy with non-confluent rash that desquamates
  • Treatment
    • Management approach
      • mainstay of treatment is supportive care
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • antipyretics
          • hydration
  • Complications
    • Seizures
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