A one-and-a-half-month-old girl presented with fever (38 °C) of 48 hours onset and irritation, associated nasal mucus. On physical examination she presented erythematous rash of small elements and the rest of normal examination.
In an initial laboratory test: leukocytes 6310/μl (segmented 67%, fallen 6%, lymphocytes 19%, monocytes 8%), hemoglobin (Hb) 10.9 g/dl, hematocrit (Hto) 29.6%, reactive protein
Lumbar puncture was performed: glucose 51.3 mg/dl, protein 133.9 mg/dl (hemorrhagic liquid).
Given the suspicion of severe bacterial infection, she was admitted for intravenous antibiotic treatment with cefoxime and ampicillin (200 mg/kg/day), adding in the following 24 hours herpes simplex virus to cover (60 mg/kg/day).
Febrile at 48 hours.
On the fourth day she presented irritation, bad color and general condition, with persistence of evanescent exanthema and respiratory distress. Control laboratory tests were performed with finding: leukocytes 2670/μl 11% atypical segments Hb 31%, lymphocytes
capillary gas: pH 7.32, PCO2 43.3 and HCO3 21.8 mmol/l.
Chest X-ray : Bilateral alveolointerstitial infiltrates Radiography, more striking on the left side, suggestive of acute pulmonary edema.
Located as pancytic, samples are extracted for parvovirus and enterovirus, as well as for influenza A. High flow therapy is initiated and the patient is transferred to a tertiary care pediatric hospital.
1.
Immunoglobulin M (IgM) for parvovirus B19 are positive and IgG negative, making diagnosis of parvovirus B19 infection, respiratory failure and pancit associated antibodies.
The patient showed progressive improvement on the fifth day of admission and was discharged on the twelfth day without further complications.
The child's brother later presents erythema infectiosum.
