Generalized petechial eruption induced by parvovirus B19 infection

doi:10.1016/j.jaad.2004.11.040

Journal of the American Academy of Dermatology

Volume 52, Issue 5, Supplement, May 2005, Pages S109-S113

https://doi.org/10.1016/j.jaad.2004.11.040 Get rights and content

Parvovirus infection classically causes erythema infectiosum. During the past 2 decades, other unusual skin eruptions have been noted in association with parvovirus infection. Papular purpuric gloves and socks syndrome is one form of parvovirus infection described mostly in white, young adult patients. Recently, there have been reports of a few patients with acropetechial syndrome consisting of a papular purpuric gloves and socks syndrome–like presentation with additional involvement of the perioral and chin area, temporally associated with acute parvovirus B19 infection. We report a case of a 7-year-old boy with serologic evidence of acute parvovirus B19 infection who developed a generalized petechial eruption with lesions concentrated on his extremities and face. We also reviewed the literature and summarized the various cutaneous presentations of parvovirus infection.

Section snippets

Case report

A 7-year-old boy was seen by his family physician with a red and swollen right third finger. The following day he became febrile with diarrhea, vomiting, fatigue, and a diffuse, blanching rash of macules and papules over his entire body with petechiae on his arms and legs. He had itchiness, particularly of the right middle finger. He denied any sore throat or joint pain. He was admitted to the hospital and a blood culture, complete blood cell count, liver function tests, and urinalysis were

Discussion

The only known virus in the Parvoviradae family to cause disease in human beings, parvovirus B19, is a nonenveloped single stranded DNA virus that typically infects and replicates in erythroid progenitor cells.1, 2

Infection with parvovirus B19 occurs worldwide; however, it seems to be more common in temperate rather than tropical climates.³ It is usually spread through the respiratory route and is more prevalent in school-age children in the late winter and early spring months.² The incubation

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Purpuric rash and fever among hospitalized children aged 0–18 years: Comparison between clinical, laboratory, therapeutic and outcome features of patients with bacterial versus viral etiology
2019, Pediatrics and Neonatology
Citation Excerpt :
Viruses, of which Respiratory Syncytial virus (RSV), Epstein Barr virus (EBV), Cytomegalovirus (CMV), enterovirus, adenovirus and parvovirus B19 represent the most common etiologic factors, were also reported in the medical literature as associated with occurrence of purpuric rashes.7 Furthermore, relatively newly identified viruses, like human metapneumovirus, coronavirus and bocavirus have also been associated with upper respiratory infections and may also cause purpuric rashes.8–11 The purpose of the present study is to describe all the cases with PRF occurring in children aged 0 ̶ 18 years diagnosed and hospitalized at the pediatric departments of the Soroka University Medical Center, Beer-Sheva, Israel, during the period 2005 ̶ 2016, and to compare their microbiologic laboratory, clinical, therapeutic and outcome characteristics in relation to the various etiologies of this syndrome.
The evaluation of children with purpuric rash and fever (PRF) is controversial. Although many of them have viral infections, on occasion such patients may be infected with Neisseria meningitidis. We described all children aged 0–18 years with PRF in southern Israel during the period 2005 ̶ 2016 and compared their microbiologic, laboratory, clinical and outcome characteristics in relation to various etiologies of this syndrome.
Data were summarized from electronic patient and microbiology files. Viral diagnoses were made by serology and/or PCR.
Sixty-nine children with PRF were admitted; 30 (43.48%), 9 (13.04%) and 30 (43.48%) had a syndrome of bacterial, viral or non-established etiology, respectively. N. meningitidis infection was diagnosed in 16/69 (23.19%) patients and in 16/30 (53.33%) patients with bacterial etiology; 14/30 (46.67%) patients suffered from a non-invasive bacterial disease (9 with Rickettsial disease). Adenovirus and Influenza B (3 and 2 cases, respectively) represented the most frequent etiologic agents among patients with viral etiology. More patients with PRF of bacterial etiology were older, of Bedouin ethnicity, looked ill on admission, had higher rates of meningitis and were treated more frequently with antibiotics compared with patients with non-bacterial PRF. Fatality rates among patients with bacterial, viral and non-established etiology were 5/30 (16.7%), 0% and 2/39 (5.1%).
Although PFR was uncommon, high rates of meningococcal infections were recorded in children with PRF, which was associated with high fatality rates. Rickettsial infections were frequent, emphasizing the need for a high index of suspicion for this disease in endemic geographic areas.
Purpura
2018, Principles and Practice of Pediatric Infectious Diseases
Estudio retrospectivo de 49 casos de infección aguda por parvovirus B19 en adultos
2015, Actas Dermo-Sifiliograficas
El objeto de nuestro trabajo es describir las características epidemiológicas, clínicas y analíticas de la infección aguda por parvovirus B19 en adultos.
Presentamos un estudio descriptivo retrospectivo de todos los casos de infección aguda por parvovirus B19, en mayores de 18 años, durante el año 2012, en el Hospital Universitario La Paz, Madrid.
Cuarenta y nueve pacientes adultos con infección aguda por parvovirus B19. La mayoría ocurrieron en mujeres jóvenes en primavera y principios de verano. La lesión cutánea fue el signo fundamental para el diagnóstico en más del 50% de los casos. Se encontraron todo tipo de exantemas purpúricos más o menos generalizados, siendo relativamente frecuente la forma de vasculitis (> 18%). Las alteraciones en el hemograma y perfil hepático, leves o moderadas, se resolvieron espontáneamente, salvo en 2 pacientes inmunodeprimidos en quienes persistió una anemia crónica.
Es la serie más amplia de infección aguda por parvovirus B19 descrita, hasta la fecha, en la literatura. Ante exantemas purpúricos de cualquier distribución o lesiones de vasculitis, sobre todo si se acompañan de fiebre y artralgias y se presentan en mujeres jóvenes en primavera, debemos sospechar una infección aguda por parvovirus B19 y recomendar medidas para evitar el contagio a personas de riesgo.
Our aim was to describe the epidemiologic, clinical, and laboratory characteristics of acute parvovirus B19 infection in adults.
This study describes all cases of acute parvovirus B19 infection in patients older than 18 years of age who were treated at Hospital Universitario La Paz in Madrid, Spain, in 2012.
Forty-nine adults were treated for acute parvovirus B19 infection. Most were young women who were infected in the spring or early summer. In over half the cases skin lesions were key diagnostic signs.We saw the full range of types of rash of purplish exanthems that were fairly generalized; vasculitis was relatively common (in > 18%). Mild or moderate abnormalities in blood counts and indicators of liver dysfunction resolved spontaneously in all but 2 immunocompromised patients, who developed chronic anemia.
This is the largest case series of acute parvovirus B19 infection published to date. This infection should be suspected on observing signs of purplish skin rashes, no matter the location or pattern of distribution, or vasculitis, especially if accompanied by fever and joint pain in young women in the spring. Measures to avoid infection should be recommended to individuals at risk.
PVB19-associated purpuric-petechial eruption with Henoch Schönlein-like distribution
2012, Journal of Clinical Virology
Purpura
2012, Principles and Practice of Pediatric Infectious Diseases, Fourth Edition
Parvovirus B19-associated purpuric-petechial eruption
2011, Journal of Clinical Virology
Citation Excerpt :
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.5,11–14 In contrast, generalized purpuric–petechial papules of our case 2 were concentrated in the trunk and the intertriginous areas without acral involvement.
Papular-purpuric gloves-and-socks syndrome, characterized by focal acral purpuric eruptions with a symmetrical distribution, is a rare but representative purpuric dermatosis closely associated with parvovirus B19 (PVB19) infection. However, several atypical presentations such as involvement of other sites and generalized involvement have been recently reported in PVB19 infected patients. Such multifaceted features can cause considerable confusion when making a diagnosis of purpuric eruption associated with PVB19.
Describe two febrile patients with atypical presentation of papular-purpuric eruptions due to PVB19 infection and discuss the distinctive features of purpuric–petechial eruptions associated with PVB19 infection.
Case reports and viral diagnosis by serologic tests and real-time PCR for PVB19 DNA in the serum.
One presented with “asymmetrical gloves without socks” distribution of papular purpuric eruptions accompanied by asymmetrical intertriginous involvement, the other with generalized distribution characterized by prominent intertriginous and truncal involvement. Both cases were followed by erythema infectiosum. Paired serum antibody analysis and real-time PCR indicated the link between the development of papular purpuric eruption and the viremic phase of primary PVB19 infection.
PVB19 infection should be considered in any patient presenting with a petechial or purpuric eruption of unclear origin, and not solely for PPGSS type presentations. Therefore, we propose a simple name “PVB19-associated purpuric–petechial eruption” to describe polymorphous purpuric–petechial eruptions due to PVB19 infection, coinciding with the viremic phase of primary infection and infectivity, characterized by a self-limiting course with a benign prognosis and common histological findings.

View all citing articles on Scopus

This supplement is made possible through the generous support of Stiefel Laboratories for the American Academy of Dermatology.

Funding sources: None.

Conflicts of interest: None identified.

View full text

Case ReportGeneralized petechial eruption induced by parvovirus B19 infection

Section snippets

Case report

Discussion

Hum Pathol

Dermatol Clin

J Am Acad Dermatol

J Am Acad Dermatol

J Infect

Diagn Microbiol Infect Dis

J Am Acad Dermatol

J Am Acad Dermatol

Pediatr Clin North Am

Lancet

J Hepatol

Papular-purpuric “gloves and socks” syndrome associated with human herpesvirus 6 infection

Arch Dermatol

Experimental parvoviral infection in humans

J Infect Dis

Papular-purpuric “gloves and socks” syndrome: primary infection with parvovirus B19?

J Am Acad Dermatol

Oral manifestations of papular-purpuric “gloves and socks” syndrome due to parvovirus B19 infection: the first case presented in Greece and review of the literature

Oral Dis

Papular purpuric rash due to parvovirus B19 with distribution on the distal extremities and the face

Clin Infect Dis

Immunohistochemical and virological study of skin in the papular-purpuric gloves and socks syndrome

Br J Dermatol

Simultaneous infection by human herpesvirus 7 and human parvovirus B19 in papular-purpuric gloves-and-socks syndrome

Arch Dermatol

Henoch-Schonlein purpura and human parvovirus infection

Pediatrics

Human parvovirus B19 infection associated with vascular purpura and vasculitis

Infection

Henoch-Schonlein purpura and human parvovirus B19

Dermatology

Prevalence of human parvovirus B19 infection in children with Henoch-Schonlein purpura

Arthritis Rheum

Petechial gloves and socks syndrome caused by parvovirus B19

Pediatr Dermatol

Case Report
Generalized petechial eruption induced by parvovirus B19 infection