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Infectious Diseases
문제

A 7-year-old school-age child is brought to the pediatric clinic with a rash that started on the face and has spread to the trunk and extremities. The mother reports the child had cold-like symptoms for several days before the rash appeared. Which assessment finding would be most characteristic of fifth disease (erythema infectiosum)?

해설
Fifth disease is characterized by a bright red 'slapped cheek' appearance on the face. Other options describe scarlet fever (sandpaper-like rash), varicella (vesicular rash), and measles (Koplik's spots).
같은 주제 다음 문제A 6-year-old child is brought to the pediatric clinic with a high fever, sore throat, and …

심화 해설


Understanding Fifth Disease (Erythema Infectiosum)


Fifth disease, caused by human parvovirus B19, is one of the classic viral exanthems of childhood, typically affecting children aged 5 to 15 years [1,2]. The infection often begins with nonspecific cold-like symptoms, which is consistent with the mother's report in the scenario. The key to identifying this condition lies in recognizing its characteristic progression through distinct cutaneous phases, with the most iconic sign appearing early in the rash's development [1].



Why the "Slapped Cheek" Appearance is the Hallmark


The bright red "slapped cheek" appearance on both sides of the face is the most characteristic assessment finding for fifth disease. This facial erythema is the first phase of the classic rash, giving the child an appearance as if their cheeks have been slapped [2]. This sign is so distinct that the condition is also widely known as "slapped cheek" syndrome [2]. The rash subsequently spreads to the trunk and extremities, often taking on a lacy, reticular pattern as it fades, which represents the later phases of the exanthem [1].



Differentiating from Other Childhood Rashes


The other options describe findings associated with different viral exanthems, and distinguishing them is a critical skill for the NCLEX-RN.

  • Option 1 (High fever with strawberry tongue and sandpaper-like rash): This presentation is classic for scarlet fever, a bacterial infection caused by group A Streptococcus, not a viral illness like fifth disease.

  • Option 2 (Vesicular rash that crusts over in different stages): This describes the pathognomonic rash of varicella (chickenpox), which is characterized by lesions in various stages (papules, vesicles, and crusts) all present at the same time.

  • Option 4 (Koplik's spots in the mouth with maculopapular rash): This is the hallmark of rubeola (measles). Koplik's spots are tiny, bluish-white spots on the buccal mucosa that appear before the characteristic maculopapular rash.


The clinical presentation in the question—a rash starting on the face with a preceding mild respiratory illness in a school-age child—strongly points to a viral exanthem. The "slapped cheek" sign is the specific, distinguishing feature that confirms the diagnosis of erythema infectiosum, making it the most characteristic finding to assess for [1,2]. While parvovirus B19 can cause more serious complications like aplastic crisis in vulnerable patients, the classic and most common presentation in a healthy child is this distinctive facial rash [2].
References (research sources)
  • [1]
    Erythema InfectiosumResearch articleSyed HA, Waymack JR. (2026)
  • [2]
    Parvovirus B19 InfectionResearch articleMacri A, Chamarthi VS. (2026)

임상 시나리오

Clinical Assessment Guide for Fifth Disease

When assessing a school-age child with a suspected viral exanthem, focus on the rash's origin and morphology. Fifth disease (erythema infectiosum) caused by parvovirus B19 typically follows a prodrome of mild upper respiratory symptoms. The rash evolves in three distinct stages, and recognizing the initial phase is critical for diagnosis and differentiation from other exanthems.

Key Assessment Findings
  • Prodrome: Nonspecific cold-like symptoms (low-grade fever, headache, malaise) occurring 2-5 days before the rash.
  • Phase 1 - Slapped Cheek: Intense erythema on both cheeks with circumoral pallor. This is the most characteristic finding and is often the presenting sign.
  • Phase 2 - Lacy Rash: A maculopapular, erythematous rash spreads to the trunk and proximal extremities, developing a distinctive reticular (lace-like) pattern as it fades.
  • Phase 3 - Recrudescence: The rash may fade and reappear for weeks, often triggered by sunlight, heat, exercise, or stress.
Differential Diagnosis for Pediatric Rashes
  • Scarlet Fever: High fever, sore throat, strawberry tongue, and a fine, sandpaper-like rash that blanches with pressure. Caused by Group A Streptococcus.
  • Varicella (Chickenpox): Pruritic, vesicular rash that appears in crops and progresses from macules to papules, vesicles, and crusts. Lesions in various stages are present simultaneously.
  • Measles (Rubeola): High fever, cough, coryza, conjunctivitis, and Koplik spots (white lesions on buccal mucosa) preceding a confluent maculopapular rash that spreads from head to toe.
Nursing Considerations
  • Fifth disease is usually self-limiting and requires only supportive care such as antipyretics and increased fluid intake.
  • Educate parents that the child is no longer contagious once the characteristic rash appears, as viremia occurs during the prodromal phase.
  • Advise that the lacy rash may recur for weeks with environmental triggers; this is benign and does not indicate reinfection.
  • Implement contact precautions in the healthcare setting if the patient is immunocompromised or has a hematologic disorder, as parvovirus B19 can cause aplastic crisis.

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