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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
PMH: 39 week gestation,
uncomplicated spontaneous vaginal
PSH: Denies

Meds: Tylenol 115mg q8hr PO PRN

Immunization: HepB, RV, DTaP, Hib, PCV,
IVP, influenza 2015
Allergies: No known food/drug/dyes/latex
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

General: Fever 103 x 2 days, listless,
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

Roseola Infantum
Exanthem subitum
Sixth disease

Human Herpesvirus 6 Infection (HHV-6)
Communicable DNA virus

via oral, nasal, conjunctival routes, possibly perinatal

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


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

Clinically diagnosed
R/O cause of infection if concerned about
patient condition
Labs CBC, UA, Blood culture, IgM, IgG


Symptom management
Acetaminophen 15mg/kg q4hrs
Cool baths
Lightweight clothing
Encourage fluids


Permanent immunity with one illness
Return to PCP if no symptom improvement
within 1-2 days


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