Background/Purpose

In adults, parvovirus B19 infection can induce joint symptoms and cutaneous manifestations which are known to be transient most of the time. It has been associated with the production of various antibodies directed against various autoantigens. In this study we report the immunological results in 23 adult patients with parvovirus B19 infection.

Methods

Between 1996 and 2014, 23 adult patients (mean age 35.4 ± 8.9 years; 19 women and 4 men) have been diagnosed with parvovirus B19 infection in our rheumatology department. All patients have been examined by a rheumatologist with a mean delay of 2 weeks after the onset of symptoms and had biological tests including autoimmunity in most cases. In all cases anti-parvovirus B19 IgM were present at a level greater than anti-parvovirus B19 IgG. All patients had arthralgias, 52% of them had mild arthritis and/or tenosynovitis. Cutaneous manifestations were observed in 65% of patients. In all patients, acute joint symptoms resolved in two months, except in one who developed a HLA-B27 negative spondyloarthropathy. Autoimmune tests included search for antinuclear antibodies (ANA) in all patients, rheumatoid factor (RF) in 19 patients, anti-keratine or anti-CCP antibodies in 11 patients, anticardiolipin antibodies (ACL) in 11 patients. Furthermore, C3 and C4 were evaluated in 19 patients and cryoglobulinemia was search in 13 cases.

Results

ESR was 29 ± 17 mm/1sth. Two patients had thrombocytopenia. Five patients (22%) had ANA at moderate levels (160 in 4 cases, 320 in one case) without any specificity (no case of anti-ENA or anti-DNA antibodies). RF was positive in 2 patients (10%) and no patient had anti-CCP antibodies. ACL antibodies were detected in seven cases (63%). In three cases diagnosed before 2009, they were IgG anti-ACL at low levels (20-28 U). Since 2009, our laboratory tests both IgG and IgM ACL antibodies: 4 patients had IgM ACL at levels ranged from 22 to 51 U (normal 0-19), without IgG ACL antibody. A decrease of C3 was observed in one patient (5%) and a decrease of C4 was present in 5 patients (26%). Search for cryoglobulinemia was positive in 6 cases (46%). In five cases it was a type III cryoglobulinemia at low level and in one case these level was too small for identification.

Conclusion

Some immunological abnormalities including ANA, RF, ACL antibodies, low C4 level and cryoglobulinamia are quite often encountered in parvovirus B19 infection in adults with rheumatologic symptoms. The presence of IgM ACL antibodies and mixed type III cryoglobulinemia appears frequent in our most recent experience. These abnormalities are asymptomatic and transient, but can lead to misdiagnosis and highlight some relationships between innate immunity activation and autoimmune response.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/immunological-abnormalities-in-adult-patients-with-parvovirus-b19-infection-a-study-of-23-cases/