The four-year-old child sulked into the family doctor’s office holding each of his parents’ hands. He had a fever of 104 degrees Fahrenheit that morning and was extremely irritable, his parents said. The boy cried as I continued to interview his parents and refused to let me perform the physical exam. As his father held down his arms by his side, I listened to his heart and lungs, palpated his abdomen for any masses or tenderness, and took a look in his eyes, ears, nose, and mouth. Besides an unbelievably irritable demeanor, the physical exam was totally normally, not giving away any hints. Aside from some sort of general infectious etiology, I had no idea what might be causing his symptoms. I excused myself and headed for the door, taking one last look at the boy.
That’s when I noticed his cheeks. They were bright red. They were bright red and well circumscribed. They were bright red, well circumscribed, and present during a high fever.
A light bulb went off in my head! The boy was practically a textbook description of erythema infectiosum, or fifth disease, which is caused by parvovirus B19.
I presented my history, physical exam findings, and thoughts on the patient’s assessment and plan confidently with my attending preceptor. It was an exciting moment drawing such a direct connection between what I had learned in school and how the patient was presenting directly in front of me. I imagine these sorts of light bulb moments will continue to pop up more and more throughout the year and beyond. It may have been a small victory, but it’s definitely a sign that I’m on my way!