Parvovirus B19 infection associated with hemolytic anemia and cranial polyneuropathy

Abstract

Parvovirus B19 (PB19) is a common, widespread, small, single-stranded DNA virus which has been linked with a broad spectrum of clinical illnesses, including a variety of neurological complications such as encephalitis, meningitis, myelitis, stroke, cerebellar ataxia, and neuropathy. The authors describe a case of PB19 infection associated with hemolytic anemia and cranial polyneuropathy involving the second and third cranial nerves in a 23-year-old immunocompetent woman. The diagnosis of acute PB19 infection was established with detection of positive DNA and anti-PB19 IgM antibodies in blood samples. Antiganglioside antibody studies were performed and serum anti-GD1b IgG was strongly positive. Further investigation was normal or negative, excluding other infectious or autoimmune disorders. The patient was initially treated with a 5-day course of intravenous immunoglobulin (IGIV). Because of incomplete neurological recovery, methylprednisolone was also administered 7 days after IGIV therapy initiation. Complete resolution of clinical symptoms was observed 3 months after disease onset at follow-up visit, despite the persistence of PB19 DNA and anti-PB19 IgM antibodies in serum 5 months after the initial presentation. Our report provides evidence that PB19 could affect both the central and peripheral nervous system, possibly by triggering an autoimmune mechanism that leads to autoantibody production.

Physiology of gangliosides and the role of antiganglioside antibodies in human diseases

“…Anti-GD1b AGAs were described in a case report by Sequeira et al in a 23-year-old immunocompetent woman with a PB19 infection associated with hemolytic anemia and cranial polyneuropathy. 123 While in some cases the associations between viral infections and GBS may be coincidental, it is possible that viral infections could lead to autoimmunity e.g., by exposing endogenous structures. One possibility is that a viral infection of cells may force them to release cell membrane particles containing gangliosides, e.g., from the membrane rafts, which then, in association with viral structures, could lead to a bystander-type autoimmune response.…”

A Review of Third Nerve Palsies

“…31 The third nerve may be affected by the infections in the central nervous system and has been reported in association with tuberculosis, syphilis, Fusobacterium, Streptococcus pyogenes, cysticercosis, Lyme disease, group B streptococcus, Epstein-Barr virus, parvovirus, Cryptococcus, neurobrucellosis, and others. [32][33][34][35][36][37][38][39][40][41][42] Compression by neoplasms in the subarachnoid space is an infrequent cause of TNP.…”

Parvovirus B19 as a cause of encephalitis – a case report

“…The cases reported so far are heterogeneous. B19 encephalitis has no distinctive features compared to encephalitis caused by other pathogens, except from symptoms appearing in some patients (arthritis, rash and anemia) [2], and it can occur in immunocompetent patients without any typical features of B19 infections [4]; therefore the physician cannot depend on the absence of symptoms associated with B19 infections. Anemia mainly occurs in immunocompromised patients.…”

“…Anemia mainly occurs in immunocompromised patients. Arthropathy and rash are more common in immunocompetent patients [4]. Clinical presentation of B19-associated encephalitis includes nonspecific symptoms like headache, fever, lymphadenopathy and flu-like symptoms [6].…”

“…Incubation time ranges from 4 to 14 days, but infection may last as long as 21 days. 136 cases of neurological infections linked with parvovirus B19 have been reported so far [3][4][5]. The most common neurological manifestation of B19 infection is encephalitis; however, the virus isn't usually included in the diagnostic process.…”