Answer quizzER 1.4

quizzER Winners:

Sam Lee                Bindu Vanapali         Rob Klever

Marjan Siadat        Devon Moore            Chris Guyer

Brian Kern             Dave Mishkin

Julie Nguyen          Dave Daigle

Last Week’s Question

The answer is D.

This is a case of erythema infectiosum or Fifth’s Disease. Infection by Parvovirus B19 produces this pattern of a “slapped cheek” appearance. It is characterized by an eruption that presents initially as an erythematous malar blush followed by an erythematous maculopapular eruption on the extensor surfaces of extremities that evolves into a reticulated, lacy, mottled appearance. Fever and other symptoms may be present but are uncommon. In patients with chronic hemolytic anemias like sickle cell disease, aplastic anemia is a serious complication.  Pregnant women should avoid exposure to this virus, since it may cause fetal hydrops in 10% of cases.
The article by Kellermayer, R. “Clinical presentation of parvovirus B19 infection in children with aplastic crisis”. The Pediatric infectious disease journal. 22 (12), p. 1100.
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Sickle cell patients can develop osteomyelitis (a), however, the clinical presentation is inconsistent. Patients with osteomyelitis caused by Salmonella species are generally those with sickle cell disease.  However, the most common organism that causes osteomyelitis in patients with sickle cell disease is Staphylococcus aureus.  Encephalitis (b) is an inflammation of the brain parenchyma and is not commonly caused by Parvovirus. Common etiologic agents include herpes simplex, herpes zoster, varicella-zoster, West Nile virus, and toxoplasmosis. Pneumonia (c) is a common diagnosis in patients of all ages. In children, the most common causative agents are viral. The most commonly found bacterial agent is S. pneumonia. Meningitis (e) is an infection of the meninges that surround the brain. It is caused by viral and bacterial entities. The most common bacterial agents include: E. coli, Group B streptococcus, and L. monocytogenes in very young infants and S pneumonia, N meningitides, and H influenza in older children.

Thank you for everyone who submitted an answer.  Please stay tuned for next week’s quizzER.

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.

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