Background/Purpose: Human parvovirus B19 (HPV-B19) is well known as a cause of erythema infectiosum during childhood, pure red cell aplasia in immunocompromised persons, transient aplastic crisis in patients with hereditary hemolytic anemia, and hydrops fetalis during pregnancy. We sought to describe the characteristics and outcome of the systemic manifestations of HPV-B19 primary infection in adults, whose spectrum is poorly identified and treatment uncodified.

Methods: We conducted an observational, retrospective, multicenter study, with the help of the Société Nationale Française de Médecine Interne and the Club Rhumatismes et Inflammation. Cases was defined by at least one diagnostic criterion of recent HPV-B19 infection: IgM antibodies or viral DNA presence in blood and/or another tissue.

Results: We collected 23 observations over the period 2001-2016. Median patient age at diagnosis was 37.9 years (range: 22.7-83.4). There was a female predominance (sex-ratio: 3.6/1). Median time to diagnosis was 11 days (0-197). Only 2 patients had underlying predisposing condition (sickle cell disease, pregnancy). The most common manifestations were joint involvement (87.0%), with peripheral and symmetrical polyarthralgia in all cases and sometimes arthritis (34.8%) or axial involvement (8.7%). Cutaneous symptoms were also frequent (56.5%) and manifested predominantly by rash (21.7%) with or without classical papular-purpuric gloves and socks syndrome (17.4%); when biopsy was performed, it revealed leucocytoclastic vasculitis in 2/3 cases and neutrophilic dermatosis in 1/3 cases. Four patients (17.4%) had renal involvement, with histological documentation in 2 cases (endocapillary proliferative glomerulonephritis, membranoproliferative glomerulonephritis). Two patients (8.7%) presented with lower limbs myositis, and two others with peripheral nervous system involvement (mononeuritis multiplex, Guillain-Barré syndrome). Other disorders included hemophagocytic lymphohistiocytosis, myopericarditis, pleural effusion, lymphadenopathy and splenomegaly mimicking lymphoma, and spleen infarct. Immunologic abnormalities were frequently observed: anti-nuclear antibodies (43.5%), anti-dsDNA antibodies (21.7%), anti-phospholipid antibodies (17.4%), hypocomplementemia (21.7%), anti-neutrophil cytoplasmic antibodies (13.0%), rheumatoid factor (13.0%), and mixed cryoglobulinemia (8.7%). After 6 months, all patients survived, and 47.8% were in complete remission. In 2 patients, joint involvement evolved into rheumatoid arthritis. Only 5 patients (21.7%) received intravenous immunoglobulin (IVIg), with a good response in the 2 patients with neurological disorders but without efficacy in the 3 others.

Conclusion: HPV-B19 is responsible for a wide variety of systemic manifestations with prominent joint and skin involvement, and diagnosis can be difficult to make. IVIg therapy could be discussed in rare cases whose evolution is not spontaneously favorable, particularly in the setting of peripheral nervous system involvement, but its efficacy should be further investigated in prospective studies.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-manifestations-associated-with-parvovirus-b19-infection-in-adults-a-retrospective-study-in-23-patients/