Parvovirus B19 associated adult Henoch Schönlein purpura.
BACKGROUND
Parvovirus B19 has recently been implicated in various vasculitic syndromes including Henoch Schönlein purpura (HSP), Wegener's granulomatosis and microscopic polyarteritis. The association was established through serology, the identification of DNA in the peripheral blood and affected tissues and more recently by RNA localization to cutaneous capillary endothelium. However, direct localization of the viral DNA to the glomerular and cutaneous endothelium in HSP in correlation with the histopathologic findings has not been demonstrated.


METHODS
Skin and kidney biopsy tissues were processed for hematoxylin and eosin, immunofluorescent, polymerase chain reaction (PCR) and reverse transcriptase in situ PCR studies.


METHODS
A 64-year-old-female presented with palpable purpura and nephrotic range proteinuria. Kidney and skin biopsies showed IgA-associated mesangioproliferative glomerulonephritis and IgA-associated leukocytoclastic vasculitis, respectively. A diagnosis of HSP was rendered. Her clinical course was refractory to prednisone. Parvovirus B19 DNA and tumor necrosis factor alpha DNA were identified in the dermal and glomerular capillary endothelial cells and surrounding dermal inflammatory cells.


CONCLUSIONS
This is the first documentation of B19 localization to dermal and glomerular capillary endothelium in HSP. It is important to recognize parvovirus B19-associated adult HSP cases, as the treatment of choice is intravenous gamma globulin in concert with anti-TNFalpha therapy. In contrast immunosuppressive therapy may lead to a persistent and/or worsening disease course.
Cioc
Adina M
AM
Department of Pathology, Ohio State University, Columbus, OH 43210, USA.
Sedmak
Daniel D
DD
Nuovo
Gerard J
GJ
Dawood
Magdy R
MR
Smart
Gerry
G
Magro
Cynthia M
CM
D004279:DNA, Viral / Q000032:analysis; D004730:Endothelium, Vascular / Q000473:pathology / Q000821:virology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D011695:IgA Vasculitis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007678:Kidney Glomerulus / Q000098:blood supply / Q000473:pathology / Q000821:virology; D008875:Middle Aged; D010322:Parvoviridae Infections / Q000150:complications* / Q000473:pathology / Q000628:therapy; D016732:Parvovirus B19, Human / Q000235:genetics / Q000302:isolation & purification*; D011241:Prednisone / Q000627:therapeutic use; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012867:Skin / Q000098:blood supply / Q000473:pathology / Q000821:virology; D017211:Treatment Failure
D004279:DNA, Viral; D007166:Immunosuppressive Agents; D011241:Prednisone