Lupus-like presentation of parvovirus B19 infection.
OBJECTIVE
To describe 2 cases of parvovirus B19 (B19) infection mimicking systemic lupus erythematosus (SLE) and to identify all cases of SLE imitated by and/or associated with B19 in the medical literature.


METHODS
A computer-assisted (PubMed) search of the medical literature from 1975 to 2003 was performed using the following key words: parvovirus, B19, SLE, lupus, antibodies, auto-immunity.


RESULTS
Thirty-eight patients were identified: 35 women, 3 men; mean age = 28.8 years. Clinical manifestations were as follows: fever (24 patients); articular involvement (36 patients); cutaneous lesions (28 patients); lymphadenopathy (9 patients); hepato- and/or splenomegaly (6 patients); serositis (6 patients); renal involvement (4 patients); cerebral impairment (10 patients). Cytopenia was observed in 23 cases. Antinuclear antibodies were detected in 34 patients, anti-double-stranded DNA antibodies in 20 patients, anti-Sm antibodies in 4 patients, antinuclear ribonucleoprotein antibodies in 5 patients, anti-Ro-SSA antibodies in 4 patients, anti-La-SSB antibodies in 4 patients, and anticardiolipin and/or anti-beta2-glycoprotein I antibodies in 8 patients. Hypocomplementemia was found in 15 of 26 patients. In 19 cases, the B19 infection had a self-limiting course. In 6 cases, B19 infection occurred in a context of previously established SLE, simulating SLE exacerbation. In 6 observations, symptoms persisted several months after the viral infection. In 7 cases, the exact relationship between SLE and B19 could not be determined.


CONCLUSIONS
B19 infection may present a clinical and serological tableau making it difficult to distinguish between a viral infection and the first episode of SLE. Although B19 may modulate the clinical and biological features of rheumatic disease, studies in large series do not support a causative role for B19 in the pathogenesis of SLE.
Sève
Pascal
P
Department of Internal Medicine, Hôtel-Dieu, Hospices Civils de Lyon, Université Claude Bernard Lyon I, France. pascal.seve@chu-lyon.fr
Ferry
Tristan
T
Koenig
Martial
M
Cathebras
Pascal
P
Rousset
Hugues
H
Broussolle
Christiane
C
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D008297:Male; D010322:Parvoviridae Infections / Q000175:diagnosis* / Q000821:virology; D016732:Parvovirus B19, Human / Q000235:genetics / Q000276:immunology
D000974:Antibodies, Antinuclear; D000914:Antibodies, Viral; D004279:DNA, Viral; D007075:Immunoglobulin M