Two family members with a syndrome of headache and rash caused by human parvovirus B19

Abstract

Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. Central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 year old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. Physical examination revealed a maculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. Cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis.

Recipients potentially infected with parvovirus B19 by red blood cell products

“…On the other hand, reports of transfusion‐transmitted B19 infections are very rare. B19 virus infections in transfusion recipients might be underdiagnosed because of mild clinical symptoms like tiredness, 27,28 flu‐like symptoms, 29 or joint pain 30 . Specifically, joint pain is a frequent complaint of older recipients and can be explained by a large number of alternative causes.…”

“…B19 virus infections in transfusion recipients might be underdiagnosed because of mild clinical symptoms like tiredness, 27,28 flu-like symptoms, 29 or joint pain. 30 Specifically, joint pain is a frequent complaint of older recipients and can be explained by a large number of alternative causes. Moreover, approximately 60% to 70% of all adults are protected by neutralizing B19 antibodies stemming from past B19 infections.…”

Neurologic Manifestations Associated with Parvovirus B19 Infection

“…Most patients had typical clinical findings associated with aseptic meningitis, such as fever, neck stiffness, nausea, vomiting, and headache. Rash occurred in one-third of the patients [26][27][28][29]. The duration of symptoms ranged from 2 to 30 days.…”

“…Lymphadenopathy (in most cases, cervical lymphadenopathy) was reported in 13 (16%) of 81 patients [6,14,17,21,27,29,36,39,43,47,54]. Nine (69%) of these patients were children.…”

Caracterização molecular de eritrovírus humano B19 isolados na região amazônica.

“…A infecção pelo B19 pode causar crise aplástica nos indivíduos que estejam com stress da linhagem eritrocitária, desencadeado por hemorragia, deficiência de ferro e após transplante de medula óssea (KOJIMA et al, 1988;NIITSU et al, 1990;WEILAND et al, 1989 (FIGUEIREDO et al, 2005;HOEBE et al, 2002;PEREIRA et al, 2001). Na infância apresenta-se de forma moderada, caracterizando-se por eritema na face ( fácies "esbofeteada"), progredindo com exantema máculo-papular eritematoso para o tronco, membros superiores e inferiores.…”