(BMJ)—A healthy 1-mo infant, born at term, was admitted w/ fever and irritability. Exam: T=38.5°C; tense fontanelle; otherwise unremarkable physical exam. Labs: CBC, CRP, CSF all WNL. HSV, herpes virus types 1/2/6, parvovirus B19, CMV all neg. Stool rotavirus Ag neg. After 3 days, he developed a red palmoplantar rash. What is the dx?
Kawasaki disease
Parechovirus type 3
Staphylococcal scalded skin syndrome
Rocky Mountain spotted fever
Leptospirosis
You are correct. PCR analysis confirmed parechovirus type 3 (PeV) infxn. Dermatologic manifestations of PeV can range from a generalized erythema to the more characteristic erythematous or maculopapular palmoplantar rash. It is distinguished from other sepsis-like illnesses by the lack of inflammatory markers. The infant’s rash resolved in 48h w/ defervescence.

Arch Dis Child doi:10.1136/archdischild-2016-311044
By vgreene, 26 October, 2016

PE

By vgreene, 26 October, 2016

ECG