Human parvovirus B19 infection: its relationship with systemic lupus erythematosus.
OBJECTIVE
The clinical presentation and outcome of four cases of human parvovirus-B19 (HPV-B19) infection, initially diagnosed as systemic lupus erythematosus (SLE), were reviewed and compared with similar cases previously reported in the literature. The relationship between HPV-B19 infection and SLE is discussed.


METHODS
The medical records of four patients with documented HPV-B19 infection, initially diagnosed as SLE, were reviewed and studied in detail. A Medline search from 1985 to 1997 was performed to identify other cases reported in the literature in which a relationship between HPV-B19 and SLE had been identified in both adults and children.


RESULTS
In all of our cases, the clinical findings (fever, rash, arthritis and malaise) and hematologic data (leukopenia, thrombocytopenia, anemia, presence of autoantibodies, hypocomplementemia, etc.) had initially suggested a diagnosis of juvenile SLE. Subsequently, evidence of HPV-B19 infection at the time of clinical presentation was ascertained. In three of these cases, the disease course was self-limiting with complete clinical remission and normalization of hematologic abnormalities within 18 months; one case, however, had persistent disease activity and repeated exacerbations.


CONCLUSIONS
The occurrence of HPV-B19 infection has been documented in patients with SLE, in particular in relation to disease onset. Similarities in clinical and immunological features of viral infections and SLE at presentation may hinder the differential diagnosis between these two conditions. The family history, a self-limiting disease course and certain disease specific clinical aspects may help the pediatrician formulate an accurate diagnosis. In our patients, HPV-B19 infection may have mimicked the onset of SLE in three cases, but triggered the disease in one.
Trapani
S
S
Department of Pediatrics, University of Florence, Italy.
Ermini
M
M
Falcini
F
F
D000293:Adolescent; D000974:Antibodies, Antinuclear / Q000032:analysis; D000914:Antibodies, Viral / Q000032:analysis; D002648:Child; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D010322:Parvoviridae Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D016732:Parvovirus B19, Human / Q000276:immunology / Q000472:pathogenicity*; D011241:Prednisone / Q000627:therapeutic use
D000974:Antibodies, Antinuclear; D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; C035356:SS-A antibodies; D006886:Hydroxychloroquine; D011241:Prednisone