Questionnaire/history: Children: Prodromal symptoms (2-5 days)? - Low-grade fever? - Nasal discharge? - Headache? - Myalgia? - Mild nausea? - Diarrhoea? Diffuse erythematous facial rash, appearing on one or both cheeks (resembling a 'slapped cheek')? - Facial rash fading after 1–2 weeks (usually)? - Associated with perioral and periorbital pallor (often)? Erythematous maculopapular rash on the trunk, back, and limbs may develop a few days after the facial rash, which fades to produce a lace-like, reticular rash, usually resolving over a few days or weeks, may be associated itching? Arthropathy of the knee and ankles (rarely)? Adults: (Note: in healthy adults symptoms may be atypical and 25–50% of adults are asymptomatic) (Note: consider parvovirus B19 infection in people who are immunocompromised or who have an underlying haematological disorder, who present with sudden-onset or severe anaemia) Contact with parvovirus B19 infection (usually in a child) or known local outbreak (infectivity period before rash develops 7-10 days)? Prodromal symptoms (maybe about a week after contact)? - Mild fever? - Malaise? - Myalgia? - Headache? Maculopapular rash on the trunk, back, and limbs, which fades to produce a lace-like, reticular rash, usually resolving within a week? Symmetrical polyarthropathy following the appearance of the rash (more common in women)? - Proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands and less commonly wrists, knees, and ankles painful, swollen and stiff? - Lasting for 1-3 weeks, rarely may persist for months or years? Past medical history? Current medication? Drug allergies? Examination: Temperature? Rash (as above)? Images Investigations Management Reference(s): NICE CKS: Parvovirus B19 infection Information for patient/carer(s): NHS Health A to Z: Slapped cheek syndrome Patient UK: Parvovirus infection