Petechial Exanthem in “Bathing Trunk” Distribution Caused by Parvovirus B19 Infection

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.

Parvovirus B19-associated purpuric–petechial eruption

“…These polymorphous purpuric-petechial eruptions caused by PVB19 are acute selflimiting illness often accompanied by fever and other systemic symptoms such as fatigue, myalgia, anorexia, lymphadenopathy and arthralgia. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][18][19][20][21][22][23] In contrast to EI seen in the post-viremic phase, 24 purpuric-petechial eruptions are closely linked to the viremic phase of primary PVB19 infection. [2][3][4][5][6]8,[11][12][13][14][15][16][18][19][20][21][22] Therefore, patients with papular-purpuric eruptions caused by PVB19 are considered infectious when presenting with the rash.…”

“…Purpuric-petechial eruptions in exclusive intertriginous areas without typical acral involvement were also reported in PVB19 infected partients. 8,10 During the past two decades, only a few reports have described generalized papular-purpuric eruptions associated with PVB19 in the English literature. Six cases were reported with prominent acral and intertriginous distribution.…”

Characterizing Viral Exanthems

“…immunohistochemistry still strongly support parvovirus B19 as the main etiologic agent of PPGSS [60].…”

Generalized Petechial Rashes in Children During a Parvovirus B19 Outbreak

“…These parvovirus-associated hemorrhagic rashes seem to be uncommon, and published reports have described only solitary or sporadic cases (reviewed by McNeely et al 1 and additionally reported by others [2][3][4][5][6][7]. Most case reports emphasized the distinctively focal ("gloves and socks," 8 "bathing trunk," 5,7 or "acropetechial" 9 ) distribution of these atypical rashes, and only a few reports have described generalized petechial rashes associated with parvovirus infection. [1][2][3]10 We could find no description of an outbreak of parvovirus-associated petechial rash in the English-language medical literature.…”