Parvovirus infection mimicking systemic lupus erythematosus in a pediatric population

Abstract

Objectives: To assess the striking similarities of presentation in a pediatric population between human parvovirus B19 (HPV-B19) infection and systemic lupus erythematous (SLE).

Methods: Medical records of seven patients (ages 6 to 15) with HPV-B19 infection were reviewed retrospectively.

Results: Six of seven cases presented with a history of malar rash, and all seven had prolonged arthralgias and fatigue. Six of seven had a positive antinuclear antibody (ANA) titer ranging from 1:40 to greater than 1:640, with two patients having antibodies to Scl-70 and others to Sm, RNP, SS-A (Ro), or SS-B (La). The erythrocyte sedimentation rate (ESR) varied from 2 to 68 mm/h. Two patients presented with elevated rheumatoid factor (RF) titers of 24 and 271 IU/mL, respectively. All had elevated IgM antibody levels to parvovirus at the onset, and markedly elevated IgG levels when evaluated throughout their disease course. Over the course of 2 to 3 months, three improved, but the other four continued to have symptomatology for 14, 40, 78, and 120 weeks, respectively. Treatment was symptomatic, and no one developed classic SLE.

Conclusions: HPV-B19 infection in a pediatric patient group may present with SLE-like symptomatology and positive serology suggestive of SLE. The course of the disease is usually self-limited, though it may be prolonged in some for up to 120 weeks.