Parvovirus infection mimicking systemic lupus erythematosus

Department of Internal Medicine, Saint Louis University Health Sciences Center, MO 63104, USA.
Seminars in Arthritis and Rheumatism (Impact Factor: 3.93). 05/1995; 24(5):297-303.
Source: PubMed


There are striking similarities between human parvovirus B19 (HPV-B19) infection and systemic lupus erythematosus (SLE): both may present with malar rash, fever, arthropathy, myalgia, cytopenia, hypocomplementemia, anti-DNA, and antinuclear antibodies (ANA). Therefore, it is difficult at times to differentiate HPV-B19 infection from SLE presentation or exacerbation. We report 4 cases of HPV-B19 infection mimicking SLE and review 10 other reported cases, all of whom were women. The similarity to a typical SLE presentation was indeed striking: most patients presented with rash, arthropathy, myalgia, fever, and positive ANA. In some cases, HPV-B19 infection seemed to exacerbate SLE rather then resemble it, and differentiation was difficult. Nearly all patients improved within several weeks. However, a few patients had symptoms and laboratory abnormalities lasting more than 6 months. The possibility of HPV-B19 infection should be entertained in patients presenting with SLE-like features.

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    • "Although their clinical and laboratory features did not fulfill the diagnostic criteria for systemic lupus erythematosus (SLE) [13], their SLE-like features, including butterfly-shaped erythema and polyarthralgia, strongly suggested an increased immunological response. In addition, hypocomplementemia in Case  1, which occurs in both SLE and HPV-B19 infection [14], indicated the activation of the classical complement pathway caused by the increase in immune complexes. Therefore, in our cases, such enhanced immunity was more likely to be involved in the pathogenesis of the symptoms. "
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    ABSTRACT: Two cases of women in their thirties with past histories of atopic dermatitis and allergic rhinitis developed a low grade fever, followed by a butterfly-shaped erythema, swelling of their fingers, and polyarthralgia. Despite such symptoms that overlap with those of systemic lupus erythematosus (SLE), the diagnostic criteria for SLE were not fulfilled. Due to positive results for human parvovirus B19 (HPV-B19) IgM antibodies in the serum, diagnoses of HPV-B19 infection were made in both cases. Although acetaminophen failed to improve their deteriorating symptoms, a nonsteroidal anti-inflammatory drug (NSAID), loxoprofen, completely removed the symptoms immediately after the administration. In those cases, since the patients were predisposed to atopic disorders, an increased immunological response based on the lymphocyte hypersensitivity was likely to be involved in the pathogenesis. The immunomodulatory property of NSAID was thought to repress such lymphocyte activity and thus provided a rapid and sustained remission of the disease.
    Full-text · Article · Apr 2012 · Case Reports in Medicine
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    • "In addition, chronic parvovirus infection in immunocompetent patients has been associated with systemic necrotizing vasculitis in patients with features of polyarteritis nodosa and Wegener's granulomatosis[7,8]. Lupuslike presentation has been reported in the literature with patients presenting with arthritis, fever, polyarthralgia, pleuritic chest pain, and macular rash; some of those cases had laboratory features of low complement and cross-reactivity to autoantibodies such as a transient positive anti-nuclear anti- bodies9101112131415. Chia and Jackson[16]describe a patient with significant myopericarditis and strongly positive serum tests for parvovirus B19 DNA and IgG in the absence of any demonstrable immune defects. "
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    ABSTRACT: Human parvovirus B19, which is most commonly known to cause erythema infectiosum in children, is also known to cause infection in adults, with complications ranging from a self-limited polyarthropathy in immunocompetent patients to hydrops fetalis in pregnant women, transient aplastic crises in patients with chronic hemolytic anemias, and chronic aplastic anemia in immunocompromised hosts. We describe a previously healthy immunocompetent woman who presented with manifestations of acute parvovirus B19 infection.
    Full-text · Article · Feb 2001 · Clinical Infectious Diseases
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