Answer to Photo Quiz II

Abstract

Diagnosis: Leukocytoclastic vasculitis secondary to parvo-rheumatoid arthritis has been suggested, increased titers of IgG among patients with rheumatoid arthritis is not consistently virus B19 infection identified [7,8]. Parvovirus B19 is a DNA virus known to cause erythema Our patient's arthropathy and vasculitic rash resolved over infectiosum, arthropathies, and aplastic anemia. It is a common 48 hours with nonsteroidal antiinflammatory drug therapy, cause of human disease, with a seroprevalence rate of 50% [1]. without recurrence. She was likely exposed to this virus via Women are typically affected more often than men. Although her 14-year-old daughter, who had recently had erythema incases can be sporadic, parvovirus B19 generally causes illness fectiosum diagnosed. from late winter to early summer. This virus is associated withIn conclusion, parvovirus B19 infection often presents atypivarious dermatologic disorders including the lacy, slappedcally in adults. While our patient's prodrome and distribution check rash observed in cases of erythema infectiosum, vascular of arthropathy were not extraordinary, the appearance and purpura [2, 3], polyarteritis nodosa [4], Wegener's granulomapathological explanation of her rash were unique. Parvovirus tosis [5], and Henoch-Schönlein purpura [6]. Our patient pre-B19 dermatologic manifestations are generally self-limited; sented with parvovirus B19 -induced leukocytoclastic vasculihowever, the virus can produce a chronic vasculitis. There is tis, as confirmed on examination of a punch biopsy specimen.evidence that intravenous immuneglobulin may be beneficial Her WBC count and erythrocyte sedimentation rate were in such cases [5]. This case demonstrates that parvovirus B19 normal, typical of parvovirus B19 infection. Her hemoglobin should be considered in the differential diagnosis for all patients level was 11.6 g/dL with normal indices, and her platelet count who present with a vasculitic rash. was 135,000/mm 3 . A screen for autoimmune disorders was negative. Serologies for rubella, measles, and Epstein-Barr C. L. Cooper and S. H. Choudhrivirus were also negative. Serology for antibodies to parvo-

<i>Lactobacillus acidophilus</i> as a Cause of Liver Abscess in a NOD2/CARD15-Positive Patient with Crohn’s Disease

“…We did not find earlier reports on L. acidophilus being isolated from a liver abscess or blood culture in Crohn’s disease. Of all lactobacillus species only a few have been described as being clinically significant and causing bacteremia or endocarditis: L. casei, L. rhamnosus, L. leischmannii and L. confusus [5,6,7,8]. …”

Parvovirus B19: Twenty-five Years in Perspective

“…Vascular dilatation, endothelial swelling, and perivascular lymphocytic infiltrates are the principle histopathologic alteration of this characteristic erythematous rash [19]. There are also case reports of vasculitic rashes histologically manifested as leukocytoclastic vasculitis, but these are exceptional cases [20,21]. The clinical symptoms of parvovirus B19 infection in immunocompetent patients vary with patient age [22].…”