What are the clinical findings in roseola infantum?

Updated: Oct 09, 2020
  • Author: Christopher R Gorman, MD; Chief Editor: William D James, MD  more...
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Answer

Despite the high fever, few clinical findings are observed early in the course of roseola infantum. The lack of upper respiratory tract infection is notable, and meningeal signs and encephalopathy are not present. Gastrointestinal symptoms, signs of electrolyte imbalance, or evidence of dehydration are rarely present.

A febrile seizure, with no residual findings, may have occurred.

After an abrupt loss of fever, the characteristic rash appears. The eruption is generalized and subtle. It is composed of either discrete, small, pale pink papules or a blanchable, maculopapular exanthem that is 1-5 mm in diameter. This rash may last 2 days.

The characteristic enanthem (Nagayama spots) consists of erythematous papules on the mucosa of the soft palate and the base of the uvula. The enanthem may be present on the fourth day in two thirds of patients with roseola.

See the images below.

Roseola infantum. Image courtesy of Wikimedia Comm Roseola infantum. Image courtesy of Wikimedia Commons.
Roseola infantum. Image courtesy of Wikimedia Comm Roseola infantum. Image courtesy of Wikimedia Commons.

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