Systemic lupus erythematosus and parvovirus B-19: casual coincidence or causative culprit?
Systemic lupus erythmatosus (SLE) is a multi-system autoimmune disease characterized by auto-reactive cells and auto-antibodies, which can potentially affect all organ systems. Typical organ systems that are affected include the heart, lungs, skin, kidneys, and central nervous system. Its expression is believed to be dependent on various factors such as genetic predisposition, environmental agents, immune dysregulation, crossreactivity with auto-antigens, alterations in auto-antigens, or most likely, a combination of these. Parvovirus B19, a virus which commonly runs an asymptomatic or benign self-limiting course such as erythema infectiosum, transient aplastic crisis, flu-like symptoms, rash, arthalgia, and arthritis, has recently been associated with a number of rheumatic diseases, more specifically with SLE. Like SLE, it can present with multi- systemic symptoms resembling SLE both clinically and serologically. Similarities have been so striking that patients have been initially misdiagnosed with SLE, having fulfilled 3-5 of the criteria of the American College of Rheumatology, currently used for the diagnosis of SLE, only to discover later that they were infected by parvovirus B19. This paper will discuss parvovirus' link to SLE, its similarities and differences, and whether parvovirus can act as a trigger of, or simply mimic, SLE.
Severin
Marianne C
MC
Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel 52621.
Levy
Yair
Y
Shoenfeld
Yehuda
Y
D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D016731:Erythema Infectiosum / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000821:virology*; D016732:Parvovirus B19, Human