View source for WBR0009

 {{WBRQuestion
|QuestionAuthor=Anonymous (Edited by Ayokunle Olubaniyi and Alison Leibowitz) 
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Pediatrics, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Pediatrics, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Pediatrics, Infectious Disease
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Pediatrics, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Pediatrics, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Pediatrics, Infectious Disease
|MainCategory=Internal medicine
|SubCategory=Pediatrics, Infectious Disease
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Pediatrics, Infectious Disease
|Prompt=A 2-year-old female child is brought to the ER by her mother for a diffuse maculopapular rash on her trunk, arms, and legs. The mother mentions to you that her daughter also experienced irritability and sweating in addition to a fever of 104.3°F (40.2°C) four days prior to the onset of the rash. Which of the following is the most appropriate treatment for this patient?

[[File:Roseola rash.jpg|200px|thumb|left|The image above depicts the rash observed in the 2-year-old child.]]

|Explanation=This patient likely has Roseola or exanthem subitum (meaning sudden rash), also referred to as roseola infantum (or rose rash of infants), sixth disease (as the sixth rash-causing childhood disease) and (confusingly) baby measles, or three day fever.  It is a benign disease of children, generally under two years old, whose manifestations are usually limited to a transient rash ("exanthem") that occurs following a fever of about three day's duration.
It is caused by two human herpesviruses, HHV-6 (Human Herpesvirus Six) and HHV-7, also called Roseolovirus. 

Typically the disease affects a child between six months and three years of age, and begins with a sudden high fever of 102-104 degrees Fahrenheit (39-40 degrees Celsius). After a few days the fever subsides, and just as the child appears to be recovering, a red rash appears. This usually begins on the trunk, spreading to the limbs but usually not affecting the face.  In contrast, a child suffering from measles would usually appear more infirm, with symptoms of conjunctivitis and a cough, and their rash would affect the face and last for several days. 

There is no specific vaccine against or treatment for exanthem subitum, and most children with the disease are not seriously ill.  Treatment is usually supportive i.e., oral fluids and paracetamol/acetaminophen or ibuprofen to reduce their temperature (but never aspirin, due to the risk of Reye's Syndrome.  The rash is not particularly itchy and needs no special lotions or creams.
|AnswerA=Start penicillin VK.
|AnswerAExp=This is a self-limiting viral infection.  The use of penicillin is not indicated.
|AnswerB=Start azithromycin.
|AnswerBExp=This is a viral illness requiring supportive treatment only.
|AnswerC=Supportive care with acetaminophen or ibuprofen.
|AnswerCExp=This depicts the best choice of management.
|AnswerD=Diphenhydramine.
|AnswerDExp=This is usually not indicated.
|AnswerE=Prednisolone.
|AnswerEExp=The use of steroids is not indicated in the treatment of Roseola.
|EducationalObjectives=Roseola is a self-limiting viral illness common among children less than 3 years of age.  It usually presents as a maculopapular rash on the trunk, limbs and neck (sparing the face) shortly after an abrupt cessation of high fevers.  Treatment is largely supportive, not requiring any antibiotics.
|References=http://www.wikidoc.org/index.php/Roseola
|RightAnswer=C
|WBRKeyword=Roseola, exanthem subitum
|Approved=No
|Answer=Start penicillin VK.,Start azithromycin.,Diphenhydramine.,Prednisolone (Prelone).
}}