quizzER 1.4


A 3-year-old African American boy with a history of sickle cell disease presents to the ED after he developed a low-grade fever, runny nose, and an erythematous discoloration of both cheeks. His vital signs are heart rate 110 beats per minute, respiratory rate of 24 breaths per minute, and pulse oximetry of 98% on room air. The patient looks well and is in no acute distress. You note a macular lesion on both cheeks. The rash is not pruritic and there is no associated cellulitis or suppuration. What is the most serious complication to consider in this patient?
a.    Osteomyelitis
b.    Viral encephalitis
c.    Pneumonia
d.    Aplastic anemia
e.    Meningitis

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training.

14 Responses

  1. aplastic anemia from parvo B19

  2. d) Aplastic anemia

  3. d. aplastic anemia

  4. c. Pneumonia, particularly mycoplasma.

  5. The most serious complication in any SC patient is bacterial infection (that’s why they get to take PCN prophylaxis)
    The complication to watch out for in this 3 year old with otherwise benign, viral type symptoms is C. Pneumonia

  6. D

  7. D. Aplastic anemia- I choose this because it sounds like the child has an infection with Parvovirus B19. This is the virus that only affects humans and can lead to “slapped cheek syndrome”. In a patient with sickle cell it is dangerous because it can lead to further destruction of RBCs, and these patients already have a shortened course of RBC life. It prevents RBC production for 2-3 days via erythropoesis. This can be life-threatening. Treatment will be either supportive, or blood transfusion. The other choices are serious, but due to the presentation, this is the answer that makes the most sense. The question can throw one off and could be phrased a little differently.

  8. slapped cheeks! this is fifth disease – in sicklers, look out for an aplastic crisis ( d – aplastic anemia )

  9. D. Due to Parvo B19

  10. D. Aplastic Anemia

  11. D. Aplastic anemia

  12. D. Aplastic anemia

  13. I think it’s Parvo B19, and you’d be worried of aplastic anemia.

  14. He could develop aplastic anaemia – he has the signs of ‘slapped cheek syndrome’, an infection usually caused by Parvovirus B19. It’s usually mild and self limiting but in the child with sickle-cell could cause aplastic anaemia.

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