Parvovirus B19 infection presenting concurrently as papular–purpuric gloves‐and‐socks syndrome and bathing‐trunk eruption

Parvovirus B19 infection can cause a wide range of cutaneous manifestations, including papular–purpuric gloves‐and‐socks syndrome (PPGSS) and petechial bathing trunk eruption. We report a case of an immunocompetent woman with a primary parvovirus B19 infection presenting as concurrent PPGSS and petechial bathing trunk eruption. Parvovirus B19 seroconversion was confirmed several days after the onset of the clinical manifestations. The coexistence of these two cutaneous manifestations of primary parvovirus B19 infection has rarely been reported in the literature. It is important to recognize parvovirus B19 infection early, based on the cutaneous manifestations, to avoid potentially serious systemic complications in susceptible individuals.     

Human parvovirus B19 infection: Immunohistochemical and electron microscopic studies of skin lesions

Erythema infectiosum is known to be caused by human parvovirus B19 and shows characteristic clinical skin manifestations in children, although adult cases of human parvovirus B19 infection do not always show such characteristic features. Recently, we experienced an epidemic adult cases of human parvovirus B19 infection and examined the erythematous skin lesion by immunohistochemistry and electron microscopy to clarify the pathogenesis of the skin manifestations. Light microscopic examination showed slightly irregular-shaped vessels in the dermis. By immunohistochemistry, using anti-human parvovirus B19 monoclonal antibody, positive reactions were found in endothelial cells. No immunoglobulins were found, but C3 deposits were present in the perivascular areas. By electron microscopy, virus particles were found in the cytoplasm of endothelial cells. An inflammatory reaction due to the direct human parvovirus B19 infection in dermal vessels seems to be an important factor in the pathogenesis of the skin manifestations.     

Melkersson–Rosenthal syndrome associated with parvovirus b19 viraemia and haemophagocytic lymphohistiocytosis

We describe a 23‐year‐old patient who presented acutely with haemophagocytic lymphohistiocytosis (HL) and Melkersson–Rosenthal syndrome (MRS). MRS and HL are two unusual and complex clinical patterns that may present acutely and to our knowledge, an association between them has never been reported. The clinical investigations in this patient led to identification of parvovirus B19 (PB19) viraemia by PCR. Parvovirus infection has been reported as a cause of virus‐associated HL, but the presence of PB19 has never been sought or reported as a possible trigger for MRS. This observation suggests a possible association between PB19 and HL, and opens the possibility of its association also with acute‐onset MRS. Further investigations for the presence of PB19 in cases of MRS are warranted.     

Increased prevalence of human parvovirus B19 DNA in systemic sclerosis skin

BACKGROUND: Human parvovirus B19 is a small, single-stranded DNA virus encoding two structural capsid proteins and a nonstructural protein. It is the aetiological agent of erythema infectiosum and transient aplastic crisis in patients with haemolytic anaemia, and has been associated with fetal death, arthritis and chronic anaemia. In recent years, the possible involvement of parvovirus B19 in systemic sclerosis (SSc) has been reported. OBJECTIVES: To determine whether human parvovirus B19 DNA can be detected in SSc skin tissue specimens. METHODS: Normal subjects (n = 97) and patients with SSc (n = 48), systemic lupus erythematosus (n = 16), dermatomyositis (n = 8), morphoea (n = 6) and graft-versus-host disease (n = 8) were studied. Crude DNA was extracted from skin tissue specimens. We attempted to determine whether human parvovirus B19 could be detected in the skin of SSc using nested polymerase chain reaction (PCR). PCR amplification was performed with specifically designed first and second primer pairs for parvovirus B19 DNA. RESULTS: After the first PCR, the occurrence rate of parvovirus B19 DNA in SSc skin tissues (36 of 48, 75%) was significantly elevated in comparison with that in normal controls (50 of 97, 52%) (P < 0.01). After the second PCR, the occurrence rate of parvovirus B19 DNA in SSc skin tissues (36 of 48, 75%) was significantly elevated compared with that in normal controls (53 of 97, 55%) (P < 0.02). The occurrence rates in the other diseases showed no significant difference from that in normal controls. CONCLUSIONS: The increased prevalence of human parvovirus B19 DNA in SSc skin showed the possibility that the virus may be involved in the formation of skin tissue abnormalities in the disease.     

Viral exanthems in childhood – infectious (direct) exanthems. Part 2: Other viral exanthems

The group of the non‐classic infectious exanthems are mostly maculopapular or vesicular. The latter changes are typical for infections with varicella‐zoster virus and Coxsackie viruses. Congenital cytomegalovirus infections are characterized by petechiae and purpura, while the papular‐purpuric gloves and socks syndrome is usually associated with parvovirus B19. Aside from these, the non‐classic infectious exanthems diseases include nonspecific exanthems coupled with respiratory and enteric infections.     

Angio-oedema in a neonate with IgG antibodies to parvovirus B19 following intrauterine parvovirus B19 infection

We report a neonate with angio-oedema following fetal hydrops caused by maternal parvovirus B19 infection. Levels of complement components, including total haemolytic complement activity and C1 inhibitor concentration, were within normal ranges in cord blood. Neonatal angio-oedema might be included in the clinical spectrum of parvovirus B19 infection in pregnancy.     

Parvovirus B19 infection mimicking drug-induced hypersensitivity syndrome

BACKGROUND: Clinical manifestations of primary parvovirus B19 infection vary greatly. Epidermal megalerythema is the most common feature. We report a particular form resembling a drug-induced hypersensitivity reaction. CASE REPORT: A 19-year-old man had a scarlatiniform eruption associated with multiple node enlargement, elevated liver enzymes and a abnormal white cell count with mononucleosis and lymphopenia, similar to that observed in hypersensitivity reactions. Seroconversion and positive PCR search for viral DNA established the diagnosis of primary parvovirus B19 infection. The spontaneous course was favorable with no recurrence at one month. DISCUSSION: The clinical features and laboratory findings in this case of parvovirus B19 infection closely resembled drug-induced hypersensitivity syndrome. The role of viral agents in the development of hypersensitivity reactions have been suggested. It is important to look for viral infections in clinical presentations mimicking drug-induced hypersensitivity.     

Parvovirus B19 infection in children with acute illness and rash

Parvovirus B19 is responsible for a variety of cutaneous diseases, including erythema infectiosum and papular purpuric gloves-and-socks syndrome. It is also associated with other dermatologic diseases, such as systemic lupus erythematosus. To study the prevalence of parvovirus B19 infection in children with acute illness and rash, we did a prospective study of 110 children at the Chiang Mai University teaching hospital from January 2001 to November 2003. Sera from these patients were analyzed for immunoglobulin M and immunoglobulin G antibodies against human parvovirus B19 using enzyme-linked immunosorbent assay techniques. From a total of 110 patients with acute illness and rash, there were paired serum samples for 90 patients and single serum sample for 20 patients. For those with paired serum samples, there were three patients with recent parvovirus B19 infection that presented with erythema infectiosum, urticaria, and lupus erythematosus, respectively. Immunoglobulin G antibodies were tested in serum samples of 103 children; 28.2% were positive. These data indicate that parvovirus B19 is not a common cause of acute illness and rash in children.     

The association of pityriasis rosea with cytomegalovirus,Epstein-Barr virus and parvovirus B19 infections - a prospective case control study by polymerase chain reaction and serology

A viral aetiology is suspected for pityriasis rosea (PR). The objective was to investigate the association of PR with cytomegalovirus (CMV), Epstein Barr virus (EBV) and parvovirus B19 infections. Patients with PR were recruited in a primary care setting over 18 months. Blood was collected at initial presentation and four weeks later. Controls were the next age-and-sex-matched patients requiring blood collection for non-dermatological disease. Polymerase chain reaction was performed for EBV and parvovirus B19 DNA. Serology was done for CMV, EBV and parvovirus B19. 12 patients with PR and 12 control subjects were recruited. No patient had viral DNA or significant antibody rise against any of the viruses investigated. The seroprevalence of all three viruses and Ab titres in the patients with PR were insignificantly different from those of control subjects. Two patients had IgM detectable against CMV and EBV respectively. Based on other investigation results, we believe that both IgM results were caused by cross reactivity. PR is not associated with CMV, EBV or parvovirus B19 infections.     

Acute heart failure associated with human parvovirus B19 infection

We report a patient with acute heart failure due to human parvovirus B19 infection. The patient was a 36-year-old man with polyarthralgia, fatigue and swelling of his upper eyelids and all four limbs. These symptoms disappeared, but 5 days after the first consultation, the patient presented with severe exertional dyspnoea, chest pain and swelling of his whole body. Erythema was observed on the skin of hands, fingers and abdomen. Pleural and pericardial effusion, ascites and hepatosplenomegaly were detected. Laboratory examination showed positive results for anti-human parvovirus B19 IgM and B19 DNA in the serum. A diagnosis of acute heart failure by pericarditis caused by B19 was made. This case report suggests that B19 should be considered as a cause of acute heart failure through acute pericarditis.     

Acute generalized exanthematous pustulosis in hypercalcemia

BACKGROUND: We report a case of typical exanthematous pustulosis rash that was particularly severe both clinically and biologically. Laboratory tests led to the diagnosis of acute parvovirus B19 infection. CASE REPORT: A 23-year-old man with no past medical history developed fever with an erythematous pustulosis rash predominantly involving the folds. Blood cell count revealed hyperleukocytosis. There was no previous drug intake. This skin reaction was associated with severe systemic manifestations including hypovolemic shock, and hematologic and metabolic disturbances. Virology tests revealed acute parvovirus B19 infection. The hospital physician caring for this patient also presented evidence of acute parvovirus B19 infection. DISCUSSION: The clinical features and the course of this skin eruption were typical of generalized exanthematous pustulosis. We discuss the rare viral causes of acute generalized exanthematous pustulosis and compare our case with a previously reported case of acute generalized exanthematous pustulosis with mononucleosic syndrome in a patient with no prior drug intake. The clinical and biological manifestations of this case were similar to drug hypersensitivity syndrome.     

Gloves and socks syndrome associated with parvovirus B19 infection

The spectrum of disease caused by parvovirus B19 infection ranges from asymptomatic to a serious disease. Parvovirus B19 plays a role in the pathomechanism of gloves and socks syndrome, erythema infectiosum, acute polyarthralgia, aplastic crisis in persons with hemolytic anemia, and birth defects. Gloves and socks syndrome has an acute febrile course. Painful edema of hands and feet, and numerous small confluent petechiae in the same localization are the most characteristic signs. Blisters and erosions may occur in oral mucosa. General discomfort and arthralgia accompany skin lesions. The disease tends to be self-limiting. A typical case of gloves and socks syndrome in a 36-year-old woman is reported. Serological tests disclosed the parvovirus B19 infection, confirming the causal relationship between the syndrome and this infection.     

Variable presentation of parvovirus B19 in a family

This case report of the sequential presentation of parvovirus B19 in a family deseribes a 38-year-oid woman initially presenting with gloves and socks' syndrome; along with her husband and five children who also were affected. A high clinical attack fate with. prolonged illness and/unable clinical presentations was demonstrated, including polyarthritis, erythema infectiosum and symptoms of a respiratory tract infection. In addition, the range of syndromes and clinical features of parvovirus B19 are presented.     

Immunohistochemical and virological study of skin in the papular-purpuric gloves and socks syndrome

Summary The pathogenesis of viral exanthems remains unclear. We have undertaken an immunohistochemical study of lesional skin biopsies in patients with the papular-purpuric gloves and socks syndrome (PPGSS) secondary to parvovirus B19 infection. Intracytoplasmic staining of the dermal endothelial cells, keratinocytes, and sweat glands was shown with an antibody to parvovirus B19. There were perivascular dermal infiltrates with T cells, sometimes with exocytosis. By polymerase chain reaction, virus DNA was detected in all skin biopsies and in one serum sample. The cutaneous manifestations of parvovirus infection seem secondary to infection of the endothelium and epidermis.     

Acute generalized exanthematous pustulosis associated with a human parvovirus B19 infection

Acute generalized exanthematous pustulosis (AGEP) is a reaction pattern with characteristic clinical features. AGEP typically presents with at least dozens of non-follicular sterile pustules in addition to fever and elevated blood neutrophils. The onset is acute and pustules tend to resolve spontaneously. We herein report the findings of a 33-year-old female who presented with erythema on her elbows and dorsal thighs. Before onset, she did not receive any medications. She had no history of psoriasis, had not touched mercury, did not use tampons and was not pregnant. On the third eruptive day, she developed more than 100 non-follicular pustules in diffuse edematous erythema on her trunk and extremities, predominantly involving the intertriginous areas and she also demonstrated high fever. Her temperature returned to within the normal limits on the fourth eruptive day and the pustules thereafter dramatically vanished until the fifth eruption day. Enzyme immunoassays (EI) were performed for anti-virus antibodies and revealed a seroconversion of antihuman parvovirus B19-specific immunoglobulin (Ig)G antibodies, thus indicating a primary human parvovirus B19 infection. The most frequent causes of AGEP seem to be a drug reaction and enterovirus infection. However, AGEP has not yet been reported to be associated with human parvovirus B19. We speculated that human parvovirus B19 may therefore be one of the causative agents of AGEP.     

Petechial Gloves and Socks Syndrome Caused by Parvovirus B19

Abstract: This report describes a 14-year-old boy with petechial gloves and socks syndrome associated with acute parvovirus B19 infection. This represents only the second child reported with this distinctive exanthem.     

Parvovirus B19: a review

Infection with parvovirus B19 may result in a wide range of dermatologic manifestations. The specific skin findings include erythema infectiosum and papular purpuric "gloves-and-socks" syndrome. The nonspecific findings include reticular erythema, maculopapular eruptions, and petechiae and purpura, as well as other less frequently described findings. Associations with other dermatologic diseases, such as erythema multiforme and erythema nodosum, also have been described. A role in the pathogenesis of various collagen vascular disorders has been suggested and is under investigation. The diagnosis of infection rests on the typical clinical findings. Whenever parvovirus B19 infection is diagnosed, the physician must ensure that neither the patient nor his or her contacts is a member of certain vulnerable populations. In these populations, infection with parvovirus B19 may result in devastating complications. The vulnerable populations include those with hematologic disease, immunosuppressed patients, and pregnant women. Treatment of infection in the healthy immunocompetent individual is asymptomatic, and the acute infections typically resolve without complications.     

Papular-purpuric "gloves and socks" syndrome in a mother and daughter

The papular-purpuric "gloves and socks" syndrome (PPGSS) is a unique exanthem characterized by petechiae with painful edema of the hands and feet extending proximally with less severity. Constitutional symptoms of fever, lethargy, and arthralgia have also been described. Human parvovirus B19 has been implicated in most cases as the causative agent. We describe a mother and her daughter presenting with the characteristic findings of PPGSS and demonstrating the seroconversion of human parvovirus B19 a few days after the onset of their illness. Additional clinical findings of cutaneous vesicles, bullae, and conjunctivitis are reported in the mother's case. To our knowledge, these are the first 2 cases of PPGSS in a household setting.     

Parvovirus infections in dermatology

Human parvovirus B19 is the causative agent of erythema infectiosum and other atypical (rubelliform) exanthemas. On account of the relatively high prevalence of B19, these infections are rather frequent. They usually occur during childhood, but also up to the age of 30, and there are various clinical manifestations. During pregnancy, B19 infection may cause hydrops of the fetus with ensuing fetal death. Anti-B19 IgM and IgG can be detected by means of ELISA or RIA; B19-DNA is identified by hybridization of nucleic acid.