Papular Purpuric Gloves and Socks Syndrome Due to Parvovirus B19 Infection

Abstract

Papular purpuric gloves and socks syndrome (also known as gloves and socks syndrome) is a relatively newly described viral dermatosis with unique characteristics. These characteristics typically include an erythematous, papular, or petechial rash and edema in an acral distribution, often with associated mucosal lesions, arthralgias, and fever. We present a case of papular purpuric gloves and socks syndrome in a 46-year-old patient with acute parvovirus B19 infection, review the descriptive literature, and summarize our evolving understanding of this disease.(Infect Dis Clin Pract 2010;18: 128Y131) P apular purpuric gloves and socks syndrome (PPGSS, also known as gloves and socks syndrome) is a viral dermatosis first described nearly 20 years ago. Its manifestations typically include an erythematous, papular, or petechial rash and edema in an acral distribution, often with associated mucosal lesions, arthralgias, and fever. Our understanding of the epidemiology of this disease is growing, and new subtleties in clinical presentation have been described over the last several years. The viral etiology of this condition, ascribed originally exclusively to parvovirus B19, seems to be more complex, arguing for a possible immune-mediated pathogenic model. We describe a case of PPGSS in a 46-year-old patient with acute parvovirus B19 infection, review the descriptive literature, and summarize our evolving understanding of this disease. CASE HISTORYA 46-year-old male furniture worker with a past medical history significant only for hypertension presented to our institution with a 3-day history of swelling and rash confined to his hands and feet. His symptoms began with several hours of prodromal malaise and low-grade fever followed by the gradual onset of swelling of both hands followed by both feet. Later the same day, he began to note a progressive red rash of the skin of all of his distal extremities followed by the onset of dull arthralgias in his ankles and wrists. Finally, on the day of admission, he began to develop significant fevers and chills. The remainder of his joints were nonpainful, and he denied rash elsewhere. He reported recent urethral discharge but denied oral or genital lesions. He had been sexually active, was monogamous with his wife, and had not been using barrier protection. His only potential sick contact was a nephew with a flulike illness 10 days prior. He had not traveled outside the United States in several years.On admission, he was noted to be febrile (temperature, 103-C). He was hemodynamically stable (blood pressure, 108/58 mm Hg; pulse rate, 98 beats per minute), with an oxygen saturation of 98% without supplemental oxygen. His examination was notable for an absence of both oropharyngeal lesions and lymphadenopathy, an unremarkable cardiopulmonary examination, and symmetrical erythema and dense petechiae of both hands and feet with abrupt demarcation to normalappearing skin at the proximal wrists and ankles. In addition, all distal extremities were moderately edematous (Figs.