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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Erythema Infectiosum: A Narrative Review. Curr Pediatr Rev 2024; 20:462-471. [PMID: 37132144 DOI: 10.2174/1573396320666230428104619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Erythema infectiosum occurs worldwide. School-aged children are most often affected. Since the diagnosis is mainly clinical, physicians should be well-versed in the clinical manifestations of erythema infectiosum to avoid misdiagnosis, unnecessary investigations, and mismanagement of the disease. OBJECTIVES The purpose of this article is to familiarize physicians with the wide spectrum of clinical manifestations and complications of erythema infectiosum associated with parvovirus B19 infection. METHODS A search was conducted in July 2022 in PubMed Clinical Queries using the key terms "Erythema infectiosum" OR "Fifth disease" OR "Slapped cheek disease" OR "Parvovirus B19". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Erythema infectiosum is a common exanthematous illness of childhood caused by parvovirus B19. Parvovirus B19 spreads mainly by respiratory tract secretions and, to a lesser extent, the saliva of infected individuals. Children between 4 and 10 years of age are most often affected. The incubation period is usually 4 to 14 days. Prodromal symptoms are usually mild and consist of lowgrade fever, headache, malaise, and myalgia. The rash typically evolves in 3 stages. The initial stage is an erythematous rash on the cheeks, with a characteristic "slapped cheek" appearance. In the second stage, the rash spreads concurrently or quickly to the trunk, extremities, and buttocks as diffuse macular erythema. The rash tends to be more intense on extensor surfaces. The palms and soles are typically spared. Central clearing of the rash results in a characteristic lacy or reticulated appearance. The rash usually resolves spontaneously within three weeks without sequelae. The third stage is characterized by evanescence and recrudescence. In adults, the rash is less pronounced than that in children and is often atypical. Only approximately 20% of affected adults have an erythematous rash on the face. In adults, the rash is more frequently found on the legs, followed by the trunk, and arms. A reticulated or lacy erythema is noted in 80% of cases which helps to distinguish erythema infectiosum from other exanthems. Pruritus is noted in approximately 50% of cases. The diagnosis is mainly clinical. The many manifestations of parvovirus B19 infection can pose a diagnostic challenge even to the best diagnostician. Complications include arthritis, arthralgia, and transient aplastic crisis. In most cases, treatment is symptomatic and supportive. When parvovirus B19 infection occurs in pregnant women, hydrops fetalis becomes a real concern. CONCLUSION Erythema infectiosum, the most common clinical manifestation of parvovirus B19 infection, is characterized by a "slapped cheek" appearance on the face and lacy exanthem on the trunk and extremities. Parvovirus B19 infection is associated with a wide spectrum of clinical manifestations. Physicians should be aware of potential complications and conditions associated with parvovirus B19 infection, especially in individuals who are immunocompromised, chronically anemic, or pregnant.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benjamin Barankin
- Department of Dermatology, Toronto Dermatology Centre, Toronto, Ontario, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
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Zhao Z, Wallace MM, Zwerner JP. A unique variant of juvenile papular-purpuric gloves and socks syndrome. Pediatr Dermatol 2020; 37:1179-1180. [PMID: 32892433 DOI: 10.1111/pde.14338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Abstract
Parvovirus B19 is the most common causative agent of papular-purpuric gloves and socks syndrome (PPGSS), an often-underreported condition in the pediatric population. Classically, PPGSS presents with a papular-purpuric and at times petechial eruption of the hands and feet. (Dermatology. 1994;188:85; Int J Dermatol. 1996;35:626) We report a unique variant of juvenile PPGSS with prominent involvement of the flexural and extensor elbows, wrists, and knees.
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Affiliation(s)
- Zijun Zhao
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Matthew M Wallace
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey P Zwerner
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Ladha MA, Luca N, Constantinescu C, Naert K, Ramien ML. Approach to Chilblains During the COVID-19 Pandemic [Formula: see text]. J Cutan Med Surg 2020; 24:504-517. [PMID: 32741218 DOI: 10.1177/1203475420937978] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coronavirus disease (COVID-19) chilblains is a well-reported cutaneous pattern of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Through this narrative review, we provide an evidence-based overview of idiopathic and secondary chilblains, distinguishing features of COVID-19 chilblains, and a systematic clinical approach to history, examination, investigations, and treatment. In the absence of cold or damp exposure, COVID-19 should be considered as a cause of acute chilblains. The timing of onset of COVID-19 chilblains relative to active SARS-CoV-2 viremia remains unclear. Patients with suspected COVID-19 chilblains should thus follow public health guidelines for COVID-19 testing and self-isolation.
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Affiliation(s)
- Malika A Ladha
- 70401 Division of Dermatology, Department of Medicine, University of Calgary Cumming School of Medicine, AB, Canada
| | - Nadia Luca
- 2129 Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary Cumming School of Medicine, AB, Canada
| | - Cora Constantinescu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Calgary Cumming School of Medicine, AB, Canada
| | - Karen Naert
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, University of Calgary, AB, Canada
| | - Michele L Ramien
- 70401 Division of Dermatology, Department of Medicine, University of Calgary Cumming School of Medicine, AB, Canada.,9978 Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, AB, Canada
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Santonja C, Santos-Briz A, Palmedo G, Kutzner H, Requena L. Detection of human parvovirus B19 DNA in 22% of 1815 cutaneous biopsies of a wide variety of dermatological conditions suggests viral persistence after primary infection and casts doubts on its pathogenic significance. Br J Dermatol 2017; 177:1060-1065. [DOI: 10.1111/bjd.15382] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 12/21/2022]
Affiliation(s)
- C. Santonja
- Department of Pathology; Hospital Universitario Fundación Jiménez Díaz; Madrid Spain
| | - A. Santos-Briz
- Departments of Pathology and Dermatology; Hospital Universitario de Salamanca; Salamanca Spain
| | - G. Palmedo
- Dermatopathologie Friedrichshafen; Friedrichshafen Germany
| | - H. Kutzner
- Dermatopathologie Friedrichshafen; Friedrichshafen Germany
| | - L. Requena
- Department of Dermatology; Hospital Universitario Fundación Jiménez Díaz/Universidad Autónoma de Madrid; Madrid Spain
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Warris A, Kroon FP. Viral Exanthems. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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6
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Vázquez-Osorio I, Mallo-García S, Rodríguez-Díaz E, Gonzalvo-Rodríguez P, Requena L. Parvovirus B19 infection presenting concurrently as papular-purpuric gloves-and-socks syndrome and bathing-trunk eruption. Clin Exp Dermatol 2016; 42:58-60. [DOI: 10.1111/ced.13013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- I. Vázquez-Osorio
- Dermatology Service; Hospital Universtario de Cabueñes; Gijón Asturias Spain
| | - S. Mallo-García
- Dermatology Service; Hospital Universtario de Cabueñes; Gijón Asturias Spain
| | - E. Rodríguez-Díaz
- Dermatology Service; Hospital Universtario de Cabueñes; Gijón Asturias Spain
| | - P. Gonzalvo-Rodríguez
- Anatomy and Pathology Service; Hospital Universtario de Cabueñes; Gijón Asturias Spain
| | - L. Requena
- Dermatology Service; Fundación Jiménez Díaz; Madrid Spain
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Bandera AR, Arenal MM, Vorlicka K, Bravo-Burguilllos ER, Vega DM, Díaz-Arcaya CV. Acute Parvovirus B19 Infection in Adults: A Retrospective Study of 49 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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9
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Rodríguez Bandera AI, Mayor Arenal M, Vorlicka K, Ruiz Bravo-Burguilllos E, Montero Vega D, Vidaurrázaga Díaz-Arcaya C. Acute parvovirus B19 infection in adults: a retrospective study of 49 cases. ACTAS DERMO-SIFILIOGRAFICAS 2014; 106:44-50. [PMID: 25109767 DOI: 10.1016/j.ad.2014.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/31/2014] [Accepted: 06/13/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Our aim was to describe the epidemiologic, clinical, and laboratory characteristics of acute parvovirus B19 infection in adults. MATERIAL AND METHODS This study describes all cases of acute parvovirus B19 infection in patients older than 18 years of age who were treated at Hospital Universitario La Paz in Madrid, Spain, in 2012. RESULTS Forty-nine adults were treated for acute parvovirus B19 infection. Most were young women who were infected in the spring or early summer. In over half the cases skin lesions were key diagnostic signs.We saw the full range of types of rash of purplish exanthems that were fairly generalized; vasculitis was relatively common (in >18%). Mild or moderate abnormalities in blood counts and indicators of liver dysfunction resolved spontaneously in all but 2 immunocompromised patients, who developed chronic anemia. CONCLUSIONS This is the largest case series of acute parvovirus B19 infection published to date. This infection should be suspected on observing signs of purplish skin rashes, no matter the location or pattern of distribution, or vasculitis, especially if accompanied by fever and joint pain in young women in the spring. Measures to avoid infection should be recommended to individuals at risk.
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Affiliation(s)
| | - M Mayor Arenal
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - K Vorlicka
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | | | - D Montero Vega
- Servicio Microbiología, Hospital Universitario La Paz, Madrid, España
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Immunohistochemical detection of parvovirus B19 in "gloves and socks" papular purpuric syndrome: direct evidence for viral endothelial involvement. Report of three cases and review of the literature. Am J Dermatopathol 2012; 33:790-5. [PMID: 22024574 DOI: 10.1097/dad.0b013e318221bc41] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Papular-purpuric "gloves and socks" syndrome is a distinctive dermatosis featuring acral pruritus, edema, and petechiae. It has been attributed in most--but not all--reported cases to Parvovirus B19 infection, on the grounds of serological proof of recent infection or detection of viral DNA by polymerase chain reaction in patient serum or biopsies. We report the immunohistochemical detection of Parvovirus B19 VP2 structural protein in the endothelial lining of dermal blood vessels in 3 examples of Papular-purpuric "gloves and socks" syndrome and review previously described immunohistochemical investigations in cutaneous involvement by this infection.
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13
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Pemira SM, Tolan RW. Mycoplasma pneumoniae infection presenting as bullous papular purpuric gloves and socks syndrome: novel association and review of the literature. Clin Pediatr (Phila) 2011; 50:1140-3. [PMID: 21878609 DOI: 10.1177/0009922811414290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited, often febrile illness with symmetric edema and erythema of the hands and feet; papular, petechial, and purpuric acral dermatosis; and mucosal lesions in children and young adults. Most of the cases of PPGSS have been reported to be caused by parvovirus B19 and other viruses. This study describes a case resulting from Mycoplasma pneumoniae infection in an adolescent male and reviews the literature.
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Papular Purpuric Gloves and Socks Syndrome Due to Parvovirus B19 Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181b9d20d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Warris A, Kroon FP. Viral exanthems. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Abstract
B19 infection-associated joint symptoms occur most frequently in adults, usually presenting as a self-limited, acute symmetric polyarthritis affecting the small joints of the hands, wrists, and knees. A small percentage of patients persist with chronic polyarthritis that mimics rheumatoid arthritis raising the question of whether B19 virus may have a role as a concomitant or precipitating factor in the pathogenesis of autoimmune conditions. Comprehensive and updated reviews address different aspects of human parvovirus infection. This article focuses on the evidence supporting the arthritogenic potential of the B19 virus and the proposed mechanisms that underlie it.
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Affiliation(s)
- Ines Colmegna
- Lowance Center for Human Immunology and Rheumatology, Emory University School of Medicine, 101 Woodruff Circle, Room 1014, Atlanta, GA 30322, USA.
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17
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Frühauf J, Massone C, Müllegger RR. Bullous papular-purpuric gloves and socks syndrome in a 42-year-old female: Molecular detection of parvovirus B19 DNA in lesional skin. J Am Acad Dermatol 2009; 60:691-5. [DOI: 10.1016/j.jaad.2008.08.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 08/21/2008] [Accepted: 08/25/2008] [Indexed: 10/21/2022]
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18
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Parez N, Dehée A, Michel Y, Veinberg F, Garbarg-Chenon A. Papular-purpuric gloves and socks syndrome associated with B19V infection in a 6-year-old child. J Clin Virol 2009; 44:167-9. [DOI: 10.1016/j.jcv.2008.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 11/17/2008] [Indexed: 11/27/2022]
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19
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Vélez A, Fernández-de-la-Puebla R, Moreno JC. Second case of papular-purpuric gloves-and-socks syndrome related to hepatitis B infection. Br J Dermatol 2008. [DOI: 10.1111/j.1365-2133.2001.04387.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Schmid D, Gabbe D, Wolnik C, Pietruschka WD. [A 28-year-old patient with exanthema on hands and feet]. Internist (Berl) 2007; 47:1284-6, one page following 1286. [PMID: 17096155 DOI: 10.1007/s00108-006-1730-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on a case of papular-purpuric gloves and socks syndrome (PPGSS). Our 28-year-old female patient showed a typical exanthema on hands and feet followed by high fever, cervical swelling of lymph nodes and general symptoms. Clinical and paraclinical tests led to a diagnosis of PPGSS. This is, in most cases, caused by viral infections, in particular by the parvovirus B19. After recovering, the daughter of our patient suffered from erythema infectiosum, a typical infection caused by parvovirus B19.
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Affiliation(s)
- D Schmid
- II. Medizinische Klinik, Dietrich-Bonhoeffer-Klinikum, Akademisches Lehrkrankenhaus der Ernst-Moritz-Arndt-Universität Greifswald, Allender Str. 30, 17036, Neubrandenburg.
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Butler GJ, Mendelsohn S, Franks A. Parvovirus B19 infection presenting as 'bathing trunk' erythema with pustules. Australas J Dermatol 2006; 47:286-8. [PMID: 17034474 DOI: 10.1111/j.1440-0960.2006.00312.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 7-year-old girl presented with acute vulval erythema and pustules, associated with a petechial eruption in her flexures and over her feet. There was a mild prodromal illness and the patient was afebrile. There were minimal symptoms associated with the rash. Skin and throat swabs were negative and blood examination showed mild neutrophilia and lymphopaenia. Parvovirus B19 IgM was detected on serology and cutaneous features resolved within 4 days. This is a further case of parvovirus B19 infection presenting as a 'bathing trunk' exanthem that has unique dermatologic features, including the presence of pustules and distant petechiae.
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Sanz-Sánchez T, Daudén E, Moreno de Vega MJ, García-Díez A. Parvovirus B19 primary infection with vasculitis: DNA identification in cutaneous lesions and sera. J Eur Acad Dermatol Venereol 2006; 20:618-20. [PMID: 16684303 DOI: 10.1111/j.1468-3083.2006.01502.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lipsker D, Boeckler P. Acute urticaria and dry cough with interstitial pneumonia: a clue for the diagnosis of primary parvovirus B19 infection. Clin Exp Dermatol 2006; 31:473-4. [PMID: 16681615 DOI: 10.1111/j.1365-2230.2006.02087.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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López-Gómez M, Gómez-Avivar P, López-Ruz MA, Jiménez-Alonso J. Varón de 35 años con fiebre y exantema purpúrico. Enferm Infecc Microbiol Clin 2006; 24:277-9. [PMID: 16725088 DOI: 10.1016/s0213-005x(06)73774-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Manuel López-Gómez
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Pta. José Fernández Martínez, ptal 7, 3oB, 18015 Granada, Spain.
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Modrow S. Parvovirus B19: the causative agent of dilated cardiomyopathy or a harmless passenger of the human myocard? ERNST SCHERING RESEARCH FOUNDATION WORKSHOP 2006:63-82. [PMID: 16329658 DOI: 10.1007/3-540-30822-9_5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Parvovirus B19 infections may cause a widespread benign and self-limiting disease in children and adults known as erythema infectiosum (fifth disease). Several further manifestations are associated with B19 infections, such as arthralgias, arthritis, leucopenia and thrombocytopenia, anaemia and vasculitis and spontaneous abortion and hydrops fetalis in pregnant women. Persistent infections with continuous virus production may occur in immunocompetent as well as in immunosuppressed individuals. Parvovirus B19 infections have been frequently implicated as a cause or trigger of various forms of autoimmune diseases affecting joints, connective tissue and large and small vessels. Autoimmune neutropenia, thrombocytopenia and haemolytic anaemia are known as sequelae of B19 infections. The molecular basis of the autoimmune phenomena is unclear. Many patients with these long-lasting symptoms are not capable of eliminating the virus or controlling its propagation. Furthermore, latent viral genomes have been detected in cells of various organs and tissues by PCR. At present, it is not clear if these cells produce viral proteins and/or infectious B19 particles, if the virus genome can be reactivated to productive replication and if the presence of viral DNA indicates a causative role of parvovirus B19 with distinct diseases.
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Affiliation(s)
- S Modrow
- Institut für Medizinische Mikrobiologie und Hygiene, Universität Regensburg, Germany.
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26
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Mackowiak P, Anderson DJ, Fangman W, Fowler VG, Corey GR, Sexton DJ. A Returning Traveler with Fever and Rash. Clin Infect Dis 2005. [DOI: 10.1086/497149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Sra KK, Torres G, Rady P, Hughes TK, Payne DA, Tyring SK. Molecular diagnosis of infectious diseases in dermatology. J Am Acad Dermatol 2005; 53:749-65; quiz 766-8. [PMID: 16243123 DOI: 10.1016/j.jaad.2004.08.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2004] [Indexed: 11/16/2022]
Abstract
UNLABELLED The molecular diagnosis of infectious disease has been growing considerably over the past decade. Nucleic acid amplification techniques, such as polymerase chain reaction, ligase chain reaction, transcription-mediated amplification, and nucleic acid sequence-based amplification, provide highly accurate diagnosis of numerous bacterial, viral, fungal, and parasitic infections involved in a variety of dermatologic diseases. In addition, signal amplification with hybrid capture, branched-DNA assays, and in situ hybridization have been used to detect numerous viral pathogens with high degrees of sensitivity and specificity. New technology that involves the use of DNA and protein microarrays has also enabled the detection of a variety of genes and gene mutations. With time, these diagnostic assays are decreasing in cost, gaining approval of the U.S. Food and Drug Administration, and becoming easier and more efficient to use. In the future, these assays will be able to deliver rapid and accurate diagnosis of infectious diseases within a single clinic visit. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with molecular diagnosis of infectious diseases in dermatology.
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Affiliation(s)
- Karan K Sra
- Department of Dermatology, Center for Clinical Studies, Houston, TX 77058, USA
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Loukeris D, Serelis J, Aroni K, Tsakris A, Voulgarelis M. Simultaneous occurrence of pure red cell aplasia and papular-purpuric 'gloves and socks' syndrome in parvovirus B-19 infection. J Eur Acad Dermatol Venereol 2005; 19:373-6. [PMID: 15857471 DOI: 10.1111/j.1468-3083.2004.01172.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Papular-purpuric 'gloves and socks' syndrome (PPGSS) has been associated with parvovirus B-19 infection. We report a case of an adult immunocompetent male who presented with PPGSS. Bone marrow examination revealed pure red cell aplasia. Parvovirus B-19 DNA was detected by polymerase chain reaction in the patient's serum, whole blood and in the cutaneous lesions. This report illustrates the variety of clinical manifestations caused by B-19 infection, presents for the first time the concurrent appearance of pure red cell aplasia and PPGSS in the same patient and, finally, suggests that PPGSS may be due to direct lytic effect of the virus.
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Affiliation(s)
- D Loukeris
- Department of Pathophysiology, School of Medicine, National University of Athens, 75 Micras Asias St, 11527, Athens, Greece
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Huerta-Brogeras M, Avilés Izquierdo JA, Hernanz Hermosa JM, Lázaro-Ochaita P, Longo-Imedio MI. Petechial exanthem in "bathing trunk" distribution caused by parvovirus B19 infection. Pediatr Dermatol 2005; 22:430-3. [PMID: 16190994 DOI: 10.1111/j.1525-1470.2005.00109.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a 13-year-old boy with a petechial rash on the genital area, in which primary infection by Parvovirus B19 was demonstrated by seroconversion. To our knowledge this is the first instance of an exanthem arising from Parvovirus B19 with an exclusive genital distribution without typical acral involvement.
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Affiliation(s)
- María Huerta-Brogeras
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sklavounou-Andrikopoulou A, Iakovou M, Paikos S, Papanikolaou V, Loukeris D, Voulgarelis M. Oral manifestations of papular-purpuric 'gloves and socks' syndrome due to parvovirus B19 infection: the first case presented in Greece and review of the literature. Oral Dis 2004; 10:118-22. [PMID: 14996283 DOI: 10.1046/j.1354-523x.2003.00986.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Papular-purpuric 'gloves and socks' syndrome (PPGSS) is a novel, rare, self-limited dermatosis initially described in 1990. It is characterized by painful, pruritic edema and erythema, rapidly evolving to papular-purpuric lesions on the distal extremities, in a gloves-and-socks distribution, accompanied by fever and oral lesions such as petechiae, vesiculopustules and small erosions. Parvovirus B19 has been implicated in most cases as the etiological factor. Herein we present the first case of PPGSS in a 42-year-old Greek man with von Willebrand disease. On admission the patient was febrile, and presented acral edema and erythema rapidly followed by purpuric lesions on the same sites, and palatal petechiae. Complete remission of the exanthem occurred 7 days after hospitalization. Clinical and laboratory evaluation including serologic tests and PCR, confirmed the presence of parvovirus B19. Review of the existing literature on this novel syndrome and its association with parvovirus B19 is also presented.
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Messina MF, Ruggeri C, Rosano M, Carcione L, Crisafulli G, Musolino C. Purpuric gloves and socks syndrome caused by parvovirus B19 infection. Pediatr Infect Dis J 2003; 22:755-6. [PMID: 12938681 DOI: 10.1097/01.inf.0000078352.67112.4f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Maria Francesca Messina
- Department of Pediatrics, University of Messina, Policlinico Universitario, Viale Gazzi, 98100 Messina, Italy.
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Alfadley A, Aljubran A, Hainau B, Alhokail A. Papular-purpuric "gloves and socks" syndrome in a mother and daughter. J Am Acad Dermatol 2003; 48:941-4. [PMID: 12789189 DOI: 10.1067/mjd.2003.91] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Abdullah Alfadley
- Department of Medicine, King Faisal Specialist Hospital, Saudi Arabia.
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González-López MA, Martínez Jiménez AL, Hidalgo García Y, Alija Senra A, Fidalgo Alvarez I. Lesiones purpúricas acrolocalizadas y fiebre. An Pediatr (Barc) 2003; 59:507-8. [PMID: 14588226 DOI: 10.1016/s1695-4033(03)78771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Harel L, Straussberg I, Zeharia A, Praiss D, Amir J. Papular purpuric rash due to parvovirus B19 with distribution on the distal extremities and the face. Clin Infect Dis 2002; 35:1558-61. [PMID: 12471578 DOI: 10.1086/344773] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2002] [Accepted: 08/15/2002] [Indexed: 11/04/2022] Open
Abstract
We describe 3 patients who presented with a distinctive clinical picture of the purpuric rash called "gloves-and-socks syndrome" which was characterized by an acral distribution of the rash that involved not only the distal part of the extremities but also the chin and perioral area. Serologic analysis for parvovirus B19 yielded positive results. Parvovirus B19 should be included in the evaluation of febrile purpura.
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Affiliation(s)
- Liora Harel
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, 49202 Israel.
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Smith SB, Libow LF, Elston DM, Bernert RA, Warschaw KE. Gloves and socks syndrome: early and late histopathologic features. J Am Acad Dermatol 2002; 47:749-54. [PMID: 12399769 DOI: 10.1067/mjd.2002.124612] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gloves and socks syndrome (GSS) is a recently described exanthem, most commonly caused by parvovirus B19. OBJECTIVE Our purpose was to describe both early and late histopathologic features of GSS. METHODS We performed histopathologic examination of biopsy specimens from a case of GSS and reviewed all the English-language literature reports of GSS to compare the reported histologic descriptions. RESULTS A total of 46 cases of GSS have been reported in the English-language literature. In 18 of those, the pathologic features were described. The histologic features of the current case evolved from a nonspecific superficial perivascular lymphocytic infiltrate to a vacuolar interface dermatitis with necrotic keratinocytes, erythrocyte extravasation, and a superficial perivascular and interstitial lymphocytic infiltrate. CONCLUSION Early lesions of GSS show nonspecific features common to viral exanthems. The late features, of a fully evolved exanthem, demonstrate a vacuolar interface dermatitis with necrotic keratinocytes, a superficial perivascular and interstitial infiltrate, and dermal hemorrhage. These late pathologic features, together with the clinical appearance of GSS, may help distinguish it from other entities.
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Affiliation(s)
- Sidney B Smith
- San Antonio Uniformed Services Health Education Consortium at Brooke Army Medical Center and Wilford Hall Medical Center, Fort Sam Houston, TX 78234, USA.
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Tonelli S, Luppi M, Morselli M, Facchini L, Potenza L, Torelli G. "Gloves and socks" papular purpuric syndrome following primary infection with parvovirus B19: a link between dermatologists and haematologists. Br J Haematol 2002; 117:773-4. [PMID: 12028062 DOI: 10.1046/j.1365-2141.2002.34645.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Higashi N, Fukai K, Tsuruta D, Nagao J, Ohira H, Ishii M. Papular-purpuric gloves-and-socks syndrome with bloody bullae. J Dermatol 2002; 29:371-5. [PMID: 12126076 DOI: 10.1111/j.1346-8138.2002.tb00284.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Papular-purpuric gloves-and-socks syndrome (PPGSS) is a disease characterized by itchy, painful acral erythema with edema, confluent papules, and purpura in a gloves-and-socks distribution and is associated with fever and mucosal lesions. Parvovirus B19 and other viral infections have been proven to be causative agents of this syndrome. Its histological findings have been the non-specific ones of interface dermatitis. Here, we report a case of PPGSS in a 44-year-old man that we believe to be the first such case in Japan. He developed, within one day, a painful edematous eruption with confluent papules and purpura on his hands and feet accompanied by high fever. A unique clinical manifestation in this case was multiple bloody bullae on the toes, which have not been previously described. Serological tests were negative for parvovirus B19, cytomegalovirus, and measles virus.
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Affiliation(s)
- Natsuko Higashi
- Department of Dermatology, Osaka City University, Medical School, Japan
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Vélez A, Fernández-de-la-Puebla R, Moreno JC. Second case of papular-purpuric gloves-and-socks syndrome related to hepatitis B infection. Br J Dermatol 2001; 145:515-6. [PMID: 11531854 DOI: 10.1046/j.1365-2133.2001.04387.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Johnson RM, Little JR, Storch GA. Kawasaki-like syndromes associated with human immunodeficiency virus infection. Clin Infect Dis 2001; 32:1628-34. [PMID: 11340536 DOI: 10.1086/320523] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2000] [Revised: 11/07/2000] [Indexed: 11/03/2022] Open
Abstract
Kawasaki disease is an acute febrile vasculitic syndrome of early childhood. It is very rarely seen in adults. Among the adult patients with Kawasaki disease who have been described, a disproportionate number are infected with human immunodeficiency virus (HIV). This suggests that the immunocompromised state may predispose individuals to this syndrome. We report our experience with 2 HIV-positive patients who presented with Kawasaki-like syndromes and review the published literature on HIV-positive patients with similar syndromes.
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Affiliation(s)
- R M Johnson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Passoni LF, Ribeiro SR, Giordani ML, Menezes JA, Nascimento JP. Papular-purpuric "gloves and socks" syndrome due to parvovirus B19: report of a case with unusual features. Rev Inst Med Trop Sao Paulo 2001; 43:167-70. [PMID: 11452327 DOI: 10.1590/s0036-46652001000300010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present a case of papular-purpuric "gloves and socks" syndrome (PPGSS) in an adult male with acute parvovirus B19 infection. The patient displayed the classical features of fever, oral lesions, and purpura on hands and feet, but the purpuric lesions on the feet evolved to superficial skin necrosis, a feature not previously described in this syndrome. We believe this is the first reported case of PPGSS occurring in Brazil.
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Affiliation(s)
- L F Passoni
- Serviço de Doenças Infecciosas e Parasitárias, Hospital dos Servidores do Estado do Rio de Janeiro, RJ, Brazil.
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Ruiz Villaverde R, Blasco Melguizo J, Gutiérrez Salmerón M. Exantema en guante y calcetín por parvovirus B19. A propósito de un caso. ACTAS DERMO-SIFILIOGRAFICAS 2001. [DOI: 10.1016/s0001-7310(01)76456-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Viral exanthems are common in childhood and account for a large number of patient visits to pediatric or family medicine clinics. Most exanthems are virtually harmless to the healthy child, but others can be signs of more significant systemic disease. Some exanthems that are benign or self-limited in the healthy child may propose significant risk to pregnant or immunocompromised individuals. Therefore, recognition of exanthems, which may be associated with certain viral illnesses, is important for the primary care provider. For example, prompt recognition of a viral exanthem caused by parvovirus may allow a pregnant female from exposing her fetus to a potentially fatal infection, or, if the exposure has already occurred, may indicate the need for appropriate fetal monitoring. In this manuscript, we review the recent literature pertaining to four characteristic exanthems that are thought to be viral in nature: papular purpuric gloves and socks syndrome; pityriasis rosea; unilateral lateral thoracic exanthem; and Gianotti-Crosti syndrome.
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Affiliation(s)
- J S Nelson
- Department of Dermatology, University of Iowa Health Care, Iowa City 52242, USA.
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Abstract
The prototypical cutaneous manifestations of human parvovirus B19 (B19) infection include a petechial eruption in a glove and stocking distribution, reticular truncal erythema, and the "slapped cheek" sign. An association with connective tissue disease (CTD) stigmata has recently been made. The clinical and dermatopathologic findings in 14 patients whose skin lesions were accompanied by serological evidence of B19 infection or documentation of B19 genome in lesional skin are presented. The authors encountered skin biopsy specimens from 14 patients who presented with skin eruptions accompanied by clinical signs or serology suggestive of antecedent B19 infection. Clinical findings were correlated to the light microscopic appearance of the lesions and the presence of B19 genome in lesional skin. The study group comprised 9 women, 3 men, and 2 boys. Eruptions characteristic of fifth disease, including the slapped cheek sign, reticulated truncal erythema, and acral petechiae, were present in 3 patients, 1 of whom later developed granuloma annulare. The other patients had atypical clinical presentations comprising an asymptomatic papular eruption (2), an eruption clinically resembling Sweet's syndrome (3), myopathic dermatomyositis (DM) (2), lupus erythematosus (LE)-like syndromes (2), and lower-extremity palpable purpura (2). Skin biopsy specimens in 12 cases showed interstitial histiocytic infiltrates with piecemeal fragmentation of collagen and a mononuclear cell-predominant vascular injury pattern. Other features included an interface dermatitis, eczematous alterations, and papillary dermal edema. Lesions with features of DM or LE also showed mesenchymal mucinosis, whereas a biopsied lesion of palpable purpura showed leukocytoclastic vasculitis (LCV). Immunofluorescent testing showed a positive lupus band test (LBT) with epidermal IgG and C5b-9 decoration in 1 patient with a systemic LE-like illness, whereas the DM patients had negative LBTs and vascular C5b-9 deposition typical for DM. Skin biopsy specimens from 11 patients, including those whose presentations resembled LE and DM, were positive for B19 genome. The dermatopathology of B19 infection suggests tissue injury mediated by delayed-type hypersensitivity, by antibody-dependent cellular immunity directed at microbial antigenic targets in the epidermis and endothelium, and by circulating immune complexes in the setting of LCV. These mechanisms appear to generate a clinical and histopathological picture that recapitulates that of CTD.
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MESH Headings
- Adult
- Antibodies, Viral/blood
- Antigens, Viral/immunology
- Child
- Child, Preschool
- Connective Tissue Diseases/diagnosis
- DNA Primers/chemistry
- DNA, Viral/analysis
- Diagnosis, Differential
- Erythema Infectiosum/blood
- Erythema Infectiosum/etiology
- Erythema Infectiosum/pathology
- Female
- Fluorescent Antibody Technique, Direct
- Fluorescent Antibody Technique, Indirect
- Humans
- Male
- Middle Aged
- Papillomavirus Infections/blood
- Papillomavirus Infections/complications
- Papillomavirus Infections/pathology
- Parvovirus B19, Human/genetics
- Parvovirus B19, Human/immunology
- Parvovirus B19, Human/isolation & purification
- Parvovirus B19, Human/pathogenicity
- Polymerase Chain Reaction
- Skin/pathology
- Skin/virology
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Affiliation(s)
- C M Magro
- Department of Pathology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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