The classic childhood presentation is a "slapped cheek" appearance followed by a reticular, erythematous eruption that is predominantly found on the extremities and may be preceded by mild systemic symptoms. Adults, more than children, may report arthritis and arthralgias.
Most cases do not require specific treatment beyond symptomatic therapy and reassurance.
Infection in pregnant women may result in fetal anemia, hydrops fetalis, or intrauterine death.
Persistent infection, lasting longer than approximately 3 weeks and accompanied by chronic anemia, may occur in people who are immunosuppressed (e.g., patients with HIV, people receiving chemotherapy or immunosuppression following transplant, or patients with congenital immunodeficiencies).
People with a high red blood cell turnover/destruction (e.g., those with hereditary spherocytosis, sickle cell disease, thalassemia, iron deficiency anemia) may develop transient aplastic crisis.
Erythema infectiosum is a childhood illness caused by infection with parvovirus B19. A "slapped cheek" appearance with a lacy eruption on the torso and extremities is the most common presentation. Parvovirus B19 infection can also be associated with arthropathy and a purpuric cutaneous eruption. Select populations may be at risk for chronic anemia or transient aplastic crises. Fetal complications include hydrops fetalis and intrauterine fetal demise.
History and exam
- close contact with other infected individuals
- bright red macular erythema of the bilateral cheeks with sparing of the nasal ridge and perioral areas
- erythematous macules and papules evolving into lacy reticular erythema, most notable on the extremities
Kari L. Martin, MD
Associate Professor of Dermatology & Child Health
University of Missouri - Columbia
KLM declares that she has no competing interests.
Dr Kari L. Martin would like to gratefully acknowledge Dr Christine T. Lauren, Dr Jon Dyer, and Dr Jennifer Holman, the previous contributors to this topic. CTL, JD, and JH declare that they have no competing interests.
Nevio Cimolai, MD
Department of Pathology and Laboratory Medicine
Children's and Women's Health Centre of British Columbia
NC declares that he has no competing interests.
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