title: Parvovirus infection mimicking systemic lupus erythematosus in a pediatric population.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Internal Medicine, Saint Louis University Health Sciences Center, MO 63104, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Moore
authors.forename: R
authors.initials: R
authors.lastname: Bandlamudi
authors.forename: S M
authors.initials: SM
authors.lastname: Alam
authors.forename: G
authors.initials: G
authors.lastname: Nesher
mesh_terms: D000293:Adolescent; D000974:Antibodies, Antinuclear / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000175:diagnosis*; D008297:Male; D010322:Parvoviridae Infections / Q000097:blood / Q000175:diagnosis*; D016732:Parvovirus B19, Human / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity*; D012189:Retrospective Studies
chemical_list: D000974:Antibodies, Antinuclear; D000914:Antibodies, Viral