Week 3 - Sick Child Summary Post:

To summarize the Week 3: Sick Child Clinical Case Presentation, J. T. is a 22-month old Caucasian male who was brought to the family practice office for a fever for the past 3 days and a rash that developed overnight. According to the child’s mother, he had not appeared to be ill despite having a high fever, which she had been managing at home with Tylenol and Motrin. She became overly concerned this morning when she noticed a rash on his chest and abdomen that had developed overnight.

The pertinent positive findings for the physical exam include the following: a diffuse erythematous, non-pruritic, maculopapular rash located on the neck and trunk, which appears to be spreading to extremities. Bilateral TMs slightly erythematous without pain. Nasal mucosa and turbinates edematous and erythemic with clear nasal drainage. Palpable cervical and posterior auricular lymphadenopathy. The child is afebrile at 99.4 rectally and is up-to-date on all immunizations.

Primary Diagnosis

• Exanthema subitum (sixth disease), unspecified (B08.20)
  • Exanthema subitum, also known as sixth disease and roseola infantum, is a common childhood acute febrile illness caused by human herpesvirus (HHV) 6, which is the primary virus; or HHV-7, a secondary virus that also causes roseola infantum (Arango & Jones, 2017). HHV-6 has 2 variants (HHV-6a and HHV-6b); however, roseola infantum is mostly associated with the HHV-6b variant, which mostly affects children 6 to 36 months old (Arango & Jones, 2017). The virus replicates in the salivary glands and is spread through saliva (Arango & Jones, 2017). Roseola is characterized by a sudden onset of high fever up to 104° F for 3-5 days (Hollier, 2018).