26F + works at daycare center + fever + rash as shown in image below; next best step in diagnosis?

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o Answer = Parvovirus IgM titers; Parvo classically viral exanthem (rash) in adults.
- 17M + high school wrestler + Hx of atopy + has burning, painful rash on trunk + lymphadenopathy +

fever; image shown below; Q asks what’s the treatment?

o Answer = oral acyclovir (or valacyclovir); diagnosis is eczema herpeticumàHSV1/2 infection superimposed on
eczema; often self-inoculated from touching cold sore then cracked skin of eczema; herpes infection can present
with fever, lymphadenopathy, and tingling, burning, and painful rash (herpetic neuralgia).

- 3M + undergoing chemotherapy for ALL + has rash as shown below; what’s the diagnosis?
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o Answer = shingles; yes, pediatric shingles “is a thing”; patient is immunocompromised due to chemotherapy.

o Shingles is aka “herpes zoster” and is caused by varicella zoster virus (VZV); herpes zoster is not a virus name;
herpes zoster literally is just another name for shingles, which is caused by VZV (human herpes virus 3; HHV3), not
HSV1/2 (HHV1/2).

- 84M + sudden-onset left-sided Bells palsy + lesions around the ear as shown below; what’s the diagnosis?

o Answer = herpes zoster oticus (VZV); shingles of facial nerve; can be associated with Bells palsy.

o Be aware shingles lesions can appear non-vesicular and black on USMLE.

o New FM form for 2CK wants you to know shingles vaccine indicated at age 60.

 - 18F + immigrated to US from Mexico in elementary school + presents with crops of pruritic vesicles on

the trunk at different stages of healing; Dx?àanswer = varicella (chickenpox); immigrant status

implies unvaccinated status; “crops of vesicles at different stages of healing” = classic VZV.

 - 2M + fever of 103-4 F for 3 days; fever abruptly subsides, followed by rash as shown below; patient’s

vaccination Hx is up to date; what’s the diagnosis?

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o Answer = roseola (HHV6); described as “spiking fever followed by a rash”; child will have high fever for 2-3 days,
followed by a rash.