Snapshot A young girl is brought to the pediatrician by her mother who complains of the sudden appearance of a rash on her daughter's cheeks that has spread to her arms and trunk. The child has not been sick for the past several months, according to the mother. Introduction Common viral exanthem observed in pediatric patients Caused by Parvovirus B-19 Often preceded by no prodrome sequence, with low-grade fever at most Epidemiology spread by contact with respiratory secretions often spreads in schools and daycare centers Sickle cell patients are at high-risk of developing aplastic crises with this disease patients with Fe-deficiency, HIV and hereditary spherocytosis are similarily at risk Presentation Symptoms prodrome often no indication of illness may have low-grade fever, but usually not rash classic "slapped cheek," erythematous appearance may be itchy starts on face, spreads to arm and trunk then legs may intensify with sun exposure and/or fever Physical exam children usually present to clinic with the classic slapped-cheek erythema followed by maculopapular rash that spreads form arms to trunk and legs forming a reticular pattern low-grade fever may have mild arthralgia temporary anemia Evaluation Diagnosis is based primarily on clinical observations, history, and physical exam CBC may show anemia that resolves with resolution of illness aplastic crisis may be evident in patients with sickle-cell anemia Serology may show antibodies against infection Differential Common cold, other viral exanthems (especially rubella) Treatment Medical management observation alone usually resolves within 5 days in most cases requiring no intervention pain control may be indicated for arthalgia and fever use acetaminophen Prognosis, Prevention, and Complications Prognosis resolves spontaneously in vast majority of cases may be lethal in patients with sickle-cell anemia or iron-deficiency anemia Prevention avoid exposure (especially in daycare and school settings) proper hand hygeine may prevent spread of illness Complications arthritis, hemolytic anemia, encephalopathy, aplastic crises congenital infection can result in fetal hydrops and death