pediatrics
Erythema Infectiosum (Parvovirus B19 Infection)
Symptoms and Signs of Erythema Infectiosum
The incubation period of parvovirus B19 infection is 4 to 14 days. Typical initial manifestations of erythema infectiosum are nonspecific flu-like symptoms (eg, low-grade fever, slight malaise). Several days later, an indurated, confluent erythema appears over the cheeks (“slapped-cheek” appearance), and a symmetric rash appears prominently on the arms, legs (often extensor surfaces), and trunk, usually sparing the palms and soles. The rash is maculopapular, tending toward confluence; it forms reticular or lacy patterns of slightly raised, blotchy areas with central clearing, usually most prominent on exposed areas. The rash and the entire illness typically last 5 to 10 days. However, the rash may recur for several weeks, exacerbated by sunlight, exercise, heat, fever, or emotional stress. This photo shows confluent erythematous rash on the face ("slapped-cheek" appearance) with a maculopapular rash on the trunk and arms. John Kaprielian/SCIENCE PHOTO LIBRARY This image shows an erythematous rash on the face ("slapped-cheek" appearance) resulting from erythema infectiosum. Image courtesy of Karen McKoy, MD. This image shows a maculopapular rash resulting from erythema infectiosum. Image courtesy of Karen McKoy, MD. A few patients (more commonly children) develop papular-purpuric gloves-and-socks syndrome (PPGSS), which causes papular, purpuric, or petechial lesions limited to the hands and feet and is often accompanied by fever and oral and/or genital lesions. Some adults with parvovirus B19 infection develop mild joint pain and swelling (nonerosive arthritis) that may persist or recur for weeks to months. 