title: Common variable immunodeficiency presenting with persistent parvovirus B19 infection.
abstract: Parvovirus B19 infection in healthy hosts is self-limited, but persistent infection has been described in patients with cellular immune defects. A 6-year-old boy presented with a 6-month history of weight loss and malaise and a 1-month history of fever and polyarticular arthritis. Parvovirus DNA was detected in plasma at 10 300 copies/mL. Levels of immunoglobulin (Ig)G, IgA, IgM, IgG-1, and IgG-2 were low, and antibody responses to vaccine antigens were impaired. HIV antibody and DNA polymerase chain reaction were negative, and the patient had normal immunophenotype, mitogen stimulation response, CD40 ligand and inducible costimulator expression, transmembrane activator and CAML interactor sequencing, genomic analysis, and fluorescent in situ hybridization for deletions at 22q11.2. Common variable immunodeficiency was diagnosed and replacement therapy with immune globulin intravenous was initiated. The parvovirus DNA level declined by half over 3 months and was undetectable at 15 months. Constitutional symptoms improved but arthritis persisted and eosinophilic fasciitis eventually developed. This case demonstrates that persistent parvovirus infection may be a presenting feature of humoral immune deficiency and can mimic juvenile rheumatoid arthritis. The infection may respond to immune globulin intravenous therapy.
authors.affiliation: Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, Louisville, KY 40202, USA.
authors.forename: Sarah T M
authors.initials: ST
authors.lastname: Adams
authors.forename: Kara M
authors.initials: KM
authors.lastname: Schmidt
authors.forename: Karen M
authors.initials: KM
authors.lastname: Cost
authors.forename: Gary S
authors.initials: GS
authors.lastname: Marshall
mesh_terms: D000069594:Abatacept; D000914:Antibodies, Viral / Q000097:blood; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000276:immunology; D002648:Child; D002908:Chronic Disease; D003131:Combined Modality Therapy; D017074:Common Variable Immunodeficiency / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans; D007116:Immunization, Passive; D018796:Immunoconjugates / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D010322:Parvoviridae Infections / Q000175:diagnosis* / Q000628:therapy; D016732:Parvovirus B19, Human / Q000235:genetics / Q000276:immunology; D016133:Polymerase Chain Reaction
chemical_list: D000914:Antibodies, Viral; D018501:Antirheumatic Agents; D018796:Immunoconjugates; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D000069594:Abatacept