title: Mononeuropathy multiplex associated with acute parvovirus B19 infection: characteristics, treatment and outcome.
abstract: To describe the characteristics of peripheral neuropathy related to acute parvovirus B19 (B19V) infection. We reviewed clinical, electrophysiological and histological data of three patients with peripheral neuropathy and positive B19V detection (IgG, IgM and PCR) compatible with acute infection. The neuropathy fulfilled criteria for mononeuropathy multiplex (MM). It could be preceded by or concurrent with a limited purpuric eruption, but systemic manifestations were absent. The first neurological symptoms were always sensory and localized in a hand. Neuropathy was initially limited to a restricted sensory part of a nerve trunk territory. The course was subacute with successive and asymmetric injury of the limb and cranial nerves. Electromyographic study confirmed the diagnosis of MM with multifocal asymmetric sensory and motor axonal loss in two patients, whereas the neuropathy was purely sensory and limited to two nerves in the other patient. Nerve biopsies showed no evidence of necrotizing vasculitis but, in one patient, revealed a lymphocytic perivascular infiltrate evocative of hypersensitivity vasculitis secondary to an infectious agent. Intravenous immunoglobulin (IVIg) was systematically administered. Long-term outcome was good but with incomplete sensory recovery and, for one patient, persistence of a functional disability. B19 V infection should be considered in the etiological assessment of MM, especially in the event of a progressive sensory disorder in the hands and a concomitant history of rash. IVIg may be an effective treatment for this inflammatory disorder.
authors.affiliation: Département de Neurologie, Hôpital de la Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. timothee.lenglet@psl.aphp.fr
authors.forename: Timothée
authors.initials: T
authors.lastname: Lenglet
authors.forename: Julien
authors.initials: J
authors.lastname: Haroche
authors.forename: Aurélie
authors.initials: A
authors.lastname: Schnuriger
authors.forename: Thierry
authors.initials: T
authors.lastname: Maisonobe
authors.forename: Karine
authors.initials: K
authors.lastname: Viala
authors.forename: Yanne
authors.initials: Y
authors.lastname: Michel
authors.forename: Farhat
authors.initials: F
authors.lastname: Chelbi
authors.forename: David
authors.initials: D
authors.lastname: Grabli
authors.forename: Paul
authors.initials: P
authors.lastname: Seror
authors.forename: Antoine
authors.initials: A
authors.lastname: Garbarg-Chenon
authors.forename: Zahir
authors.initials: Z
authors.lastname: Amoura
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouche
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020422:Mononeuropathies / Q000209:etiology* / Q000628:therapy* / Q000821:virology; D010322:Parvoviridae Infections / Q000150:complications*; D016732:Parvovirus B19, Human / Q000276:immunology / Q000472:pathogenicity*; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors