Parvovirus infection mimicking systemiclupus erythematosus

doi:10.1016/S0049-0172(95)80001-8

Seminars in Arthritis and Rheumatism

Volume 24, Issue 5, April 1995, Pages 297-303

https://doi.org/10.1016/S0049-0172(95)80001-8 Get rights and content

Abstract

There are striking similarities between human parvovirus B19 (HPV-B19)infection and systemic lupus erythematosus (SLE): both may present with malar rash, fever, arthropathy, myalgia, cytopenia, hypocomplementemia, anti-DNA, and antinuclear antibodies (ANA). Therefore, it is difficult at times to differentiate HPV-B19 infection from SLE presentation or exacerbation. We report 4 cases of HPV-B19 infection mimicking SLE and review 10 other reported cases, all of whom were women. The similarity to a typical SLE presentation was indeed striking: most patients presented with rash, arthropathy, myalgia, fever, and positive ANA. In some cases, HPV-1319 infection seemed to exacerbate SLE rather then resemble it, and differentiation was difficult. Nearly all patients improved within several weeks. However, a few patients had symptoms and laboratory abnormalities lasting more than 6 months. The possibility of HPV-B19 infection should be entertained in patients presenting with SLE-like features.

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Regarding laboratory measurements, patients usually presented with cytopenia, active urinary sediment in 33%, and proteinuria in 5.3%. On the autoantibody profile, ANAs were found in up to 70%, anti-dsDNA in 29%, and hypocomplementemia in 42% of the cases [23,27–49]. Concerning neoplasms, malignant disease usually presented with cytopenia, mainly anemia and leukopenia together with systemic manifestations [64–69].
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The connection between the type I IFN system and the environment is obvious, because the main function of this system is to provide a fast and vigorous response when viruses are encountered [13]. The development of lupus as well as disease flares has been reported in connection of viral infections [108,109], which strengthens the hypothesis that lupus sometimes can be caused by an unusual strong IFN-α response in genetically susceptible individuals. Furthermore, anti-SSA antibodies, which form very potent interferogenic ICs [110,111] appear years before the disease becomes clinical apparent [40] and can show cross-reactivity with anti-EBV1 antibodies, as mentioned above.
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: Supported in part by a grant from the State of Missouri forRegional Arthritis Centers.

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Parvovirus infection mimicking systemiclupus erythematosus

Abstract

Lancet

Lancet

Lancet

J Pediatr

Lancet

Human parvovirus B19: Historical and clinical review

Rev Infect Dis

Human parvovirus infections

Annu Rev Med

Chronic bone marrow failure due to persistent B19 parvovirus infection

N Engl J Med

Possible induction of systemic lupus erythematosus by human parvovirus

Ann Rheumatic Dis

Exacerbation of systemic lupus erythematosus during human parvovirus B19 infection

Br J Rheumatol

Parvovirus B19 infection can induce histiocytic necrotizing lymphadenitis (Kikuchi's disease) associated with systemic lupus erythematosus

Lupus

Anti-DNA and anti-lymphocyte antibodies during acute infection with human parvovirus B19

J Rheumatol

Human parvovirus-induced cytopenias: A report of five cases

Br J Haematol

Human serum parvovirus-associated vasculitis

Postgrad Med J