Parvovirus B19-associated purpureo-petechial exanthema. Differential diagnosis with non-infectious vasculitis

Clinical manifestations of parvovirus B19 infection are varied and depend on the age, hematological and immune status of the infected person. Classic manifestations of the disease include infectious erythema in children, arthritis/ arthralgia in adults, severe anemia in patients with impaired erythropoiesis and non­immune hydrops fetalis in case of intrauterine infection. In addition, various types of exanthema associated with parvovirus B19 have been described. These include “papular­purpuric gloves and socks syndrome, PPGSS”, “purpuro­petechial rash associated with parvovirus B19, PAPPE”, “acropethechial syndrome”, “asymmetric periflexural exanthema of children”, etc. In all cases, skin manifestations are characterized by a hemorrhagic rash. A certain difficulty is the differential diagnosis of such variants of parvovirus B19 infection with vasculitis of non­infectious origin, primarily with the most common IgA vasculitis (Henoch­Schonlein purpura) and cutaneous small vessel vasculitis (CSVV). The connection of vasculitis with infection in some cases is obvious and is confirmed by epidemiological observations. Infections can act as a trigger for the development of vasculitis or be its direct cause (vasculitis in this case can be classified as “vasculitis associated with a probable etiology” in the nomenclature system of the Chapel Hill Consensus Conference 2012). Considering that the nature of vasculitis is not completely clear, the question of a possible connection between their occurrence and infection with PVB19 requires further study. From a clinical point of view, the differential diagnosis of hemorrhagic exanthema associated with PVB19 and vasculitis is extremely important primarily because of the need for immediate treatment of the latter. From an epidemiological point of view, this is important, since patients with PPGSS or PAPPE are infectious throughout the period of the rash.

Apparently, additional studies, primarily histological, of a sufficient number of samples from patients with purpuric­petechial rash and serologically proven acute parvovirus B19 infection will help solve this problem.

1. Qiu J., Söderlund-Venermo M., Young N.S. Human Parvoviruses // Clinical Microbiology Reviews. 2017; 30(1): 43–113. URL: https://doi.org/10.1128/CMR.00040-16.

2. Väisänen E., Kuisma I., Phan T. G., Delwart E., Lappalainen M., Tarkka E., Hedman K., Söderlund-Venermo M. Bufavirus in feces of patients with gastroenteritis, Finland // EID Journal. 2014; 20(6):1077–1079. URL: https://doi.org/10.3201/eid2006.131674.

3. Matthews P.C., Sharp C., Simmonds P., Klenerman P. Human parvovirus 4 ‘PARV4’ remains elusive despite a decade of study // F1000Research. – 2017. URL: https://doi.org/10.12688/f1000research.9828.1.

4. Jartti T., Hedman K., Jartti L., Ruuskanen O., Allander T., S derlund-Venermo M. Human bocavirus – the first 5 years // Rev. Med. Virol. 2012; 22(1): 46–64. URL: https://doi.org/10.1002/rmv.720.

5. Cossart Y.E., Field A.M., Cant B., Widdows D. Parvovirus-like particles in human sera // The Lancet. 1975; 1(7898): 72–73. URL: https://doi.org/10.1016/s0140-6736(75)91074-0.

6. Jain A., Kant R. Genotypes of erythrovirus B19, their geographical distribution & circulation in cases with various clinical manifestations // Indian J. Med. Res. 2018; 147(3): 239–247. URL: https://doi.org/10.4103/ijmr.IJMR_1816_16.

7. Kirienko V.T., Zajceva I.A., Potij V.V., Nesteruk E.S. Parvovirusnaja infekcija V19V: obzor literatury // Aktual’naja infektologija. – 2019. – T. 7, № 5. – S. 243–251. – DOI: 10.22141/2312-413x.7.5.2019.183703.

8. Zakrzewska K., Arvia R., Bua G., Margheri F., Gallinella G. Parvovirus B19: Insights and implication for pathogenesis, prevention and therapy // Aspects of Molecular Medicine. 2023; 1: 100007. URL: https://doi.org/10.1016/j.amolm.2023.100007.

9. Mortimer P.P., Humphries R.K., Moore J.G., Purcell R.H., Young N.S. A human parvovirus-like virus inhibits haematopoietic colony formation in vitro // Nature. 1983; 302(5907): 426–429. URL: https://doi.org/10.1038/302426a0.

10. Xu P., Ganaie S.S., Wang X., Wang Z., Kleiboeker S., Horton N.C., Heier R.F., Meyers M.J., Tavis J.E., Qiu J. Endonuclease Activity Inhibition of the NS1 Protein of Parvovirus B19 as a Novel Target for Antiviral Drug Development // Antimicrob Agents Chemother. 2019; 63(3). URL: https://doi.org/10.1128/aac.01879-18.

11. Ozawa K., Ayub J., Kajigaya S., Shimada T., Young N. The gene encoding the nonstructural protein of B19 (human) parvovirus may be lethal in transfected cells //j.Virol. 1988; 62(8): 2884–2889. URL: https://doi.org/10.1128/jVI.62.8.2884-2889.1988.

12. Huerta-Brogeras M., Izquierdo J.A.A., Hermosa J.M.H., L zaro-Ochaita P., Longo-Imedio M.I. Petechial exanthem in “bathing trunk” distribution caused by parvovirus B19 infection // Pediatr. Dermatol. 2005; 22: 430–435.

13. Jordan J.A., Butchko A.R. Apoptotic activity in villous trophoblast cells during B19 infection correlates with clinical outcome: assessment by the caspase-related M30 Cytodeath antibody // Placenta. 2002; 23(7): 547–553. URL: https://doi.org/10.1053/plac.2002.0843

14. Servey J.T., Reamy B.V., Hodge J. Clinical presentations of parvovirus B19 infection // Am. Fam. Physician. 2007; 75(3):373–376.

15. Haliullina S.V. Netipichnye projavlenija sypi u rebenka, inficirovannogo parvovirusom V19 / Haliullina S.V., Shajhieva G.S., Dolovskova D.E. i dr. // Prakticheskaja medicina. – 2024. – T. 22, № 2. – S. 140–145. – DOI: 10.32000/2072-17572024-2-140-145.

16. Foti C., Bonamonte D., Conserva A., Grandolfo M., Casulli C., Martire B. Erythema infectiosum following generalized petechial eruption induced by human parvovirus B19 // New Microbiol. 2006; 29(1): 45–48.

17. Lacerda K., GanhãoI I., PrelhazI C. Caso dermatol gico // Nascer e Crescer – Birth and Growth Medical Journal. 2017; 26(3): 199–201.

18. Ferraz C., Cunha F., Mota T.C., Carvalho J.M., Sim es J.S., Aparicio J.M. Acute respiratory distress syndrome in child with human Parvovirus B19 infection // Pediatr. Infect. Dis. J. 2005; 24: 1009–1010.

19. McNeely M., Friedman J., Pope E. Generalized petechial eruption induced by parvovirus PVB19 infection //j.Am. Acad. Dermatol. 2005; 52: 109–113.

20. Butler G.J., Mendelsohn S., Franks A. Parvovirus B19 infection presenting as “bathing trunk” erythema with pustules // Australas. J. Dermatol. 2006; 47: 286–288.

21. Fretzayas A., Douros K., Moustaki M., Nicolaidou P. Papular-purpuric gloves and socks syndrome in children and adolescents // Pediatr. Infect. Dis. J. 2009; 28(3):250–252. – URL: https://doi.org/10.1097/INF.0b013e31818cb289.

22. Santonja C., Nieto-González G., Santos-Briz Á., M. de las Nieves Gutiérrez Zufiaurre, Cerroni L., Kutzner H., Requena L. Immunohistochemical detection of parvovirus B19 in “gloves and socks” papular purpuric syndrome: direct evidence for viral endothelial involvement. Report of three cases and review of the literature // Am. J. Dermatopathol. 2011; 33(8):790–795. URL: https://doi.org/10.1097/DAD.0b013e318221bc41.

23. Takeuchi M., Shiozawa R., Hangai M., Takita J., Kitanaka S. Cephalhematoma and petechial rashes associated with acute parvovirus B19 infection: a case report // BMC Infect. Dis. 2013; 13, 465. URL: https://doi.org/10.1186/1471-2334-13-465.

24. Hashimoto H., Yuno T. Parvovirus B19-associated purpuric-petechial eruption //j.Clin. Virol. 2011; 52(3): 269–271. URL: https://doi.org/10.1016/j.jcv.2011.08.004.

25. Kayalı Ş., Tuygun N., Akça H., Karacan C. Atypical Papular Purpuric Eruption Induced by Parvovirus B19 Infection // Dicle Medical Journal / Dicle Tip Dergisi diclemedj. 2016; 43(1). URL: https://doi.org/10.5798/diclemedj.0921.2016.01.0658.

26. Koliou M., Tryfonos A., Charalambous M. Purpuric rash in an adolescent with fever, pancytopenia, and an hemophagocytic lymphohistiocytosis-like syndrome due to parvovirus B19 // Clin. Case Rep. 2020; 8: 3092–3096. URL: https://doi.org/10.1002/ccr3.3335.

27. Tuccio A., Zanelli G., Rodriguez D.C., Tataranno M.L., Vascotto M., Balestri P. Petechial rash associated with Parvovirus B19 in children: case report and literature review // Le Infezioni in Medicina. 2014; 22(3): 250–254.

28. Conde-Montero E., Campos-Domínguez M., Mendoza-Cembranos M.D., Suarez Fernandez R. PVB19-associated purpuric-petechial eruption with Henoch Schönlein-like distribution //j.Clin. Virol. 2012; 55: 184–185.

29. Harel L., Straussberg I., Zeharia A., Praiss D., Amir J. Papular purpuric rash due to parvovirus PVB19 with distribution on the distal extremities and the face // Clin. Infect. Dis. 2002; 35(12): 1558–1561.

30. Pauluzzi P., Festini G., Gelmetti C. Asymmetric periflexural exanthem of childhood in an adult patient with parvovirus B19 //j.Eur. Acad. Dermatol. Venereol. 2001; 15: 372–374.

31. Drago F., Semino M., Rampiki P., Rebora A. Parvovirus infection associated with acute hepatitis and a purpuric exanthema // Br. J. Dermatol. 1999; 141: 160–161.

32. Filippi F., Lombardo V., Chessa M.A., Virdi A., Gurioli C., Neri I. Baboon-like syndrome induced by Parvovirus B19 in a child // Int. J. Dermatol. 2020; 59(5): e157–e159. URL: https://doi.org/10.1111/ijd.14778.

33. Cazorla M.B., Castro J.B., Rueda M.L., Grees S. Síndrome Baboon-like asociado a Parvovirus B19: A propósito de un caso en edad pediátrica // Revista Argentina De Dermatología. 2021; 102(3): 32–39.

34. Rodríguez Bandera I., Mayor Arenal M., Vorlicka K., Ruiz Bravo-Burguilllos E., Montero Vega D., Vidaurrázaga DíazArcaya C. Acute parvovirus B19 infection in adults: a retrospective study of 49 cases // Actas dermo-sifiliográficas (English edition). 2015; 106(1): 44–50. URL: https://doi.org/10.1016/j.adengl.2014.11.006.

35. Mage V., Lipsker D., Barbarot S., Bessis D., Chosidow O., Del Giudice P., Aractingi S., Avouac J., Bernier C., Descamps V., Dupin N. Different patterns of skin manifestations associated with parvovirus B19 primary infection in adults //j.Am. Acad. Dermatol. 2014; 71(1): 62–69. URL: https://doi.org/10.1016/j.jaad.2014.02.044.

36. Edmonson M.B., Riedesel E.L., Williams G.P., DeMuri G.P. Generalized Petechial Rashes in Children During a Parvovirus B19 Outbreak // Pediatrics. 2010; 125(4): e787–e792. URL: https://doi.org/10.1542/peds.2009-1488.

37. Von Kietzell K., Pozzuto T., Heilbronn R., Grössl T., Fechner H., Weger S. Antibody-mediated enhancement of parvovirus B19 uptake into endothelial cells mediated by a receptor for complement factor C1q / //j.Virol. 2014; 88: 8102–8115. URL: https://doi.org/10.1128/JVI.00649-14.

38. Arvia R., Margheri F., Stincarelli M.A., Laurenzana A., Fibbi G., Gallinella G., Ferri C., Del Rosso M., Zakrzewska K. Parvovirus B19 activates in vitro normal human dermal fibroblasts: a possible implication in skin fibrosis and systemic sclerosis // Rheumatology. 2020; 59: 3526–3532. URL: https://doi.org/10.1093/rheumatology/keaa230.

39. Von Kietzell K., Pozzuto T., Heilbronn R., Grössl T., Fechner H., Weger S. Antibody-mediated enhancement of parvovirus B19 uptake into endothelial cells mediated by a receptor for complement factor C1q / //j.Virol. 2014; 88: 8102–8115. URL: https://doi.org/10.1128/JVI.00649-14.

40. Schmidt-Lucke C., Zobel T., Schrepfer S., Kuhl U., Wang D., Klingel K., Becher M., Fechner H., Pozzuto T., Van Linthout S., Lassner D., Spillmann F., Escher F., Holinski S., Volk H.-D., Schultheiss H.-P., Tschope C. Impaired endothelial regeneration through human parvovirus B19-infected circulating angiogenic cells in patients with cardiomyopathy //j.In-fect. Dis. 2015; 212: 1070–1081. URL: https://doi.org/10.1093/infdis/jiv178.

41. Odinec Ju.V., Javorovich M.V. Harakteristika pokazatelej funkcional’nogo sostojanija jendotelija v dinamike zabolevanija u detej s gemorragicheskim vaskulitom // Zdorov’e rebenka. – 2016. № 6 (74). – C. 93–97. – DOI: 10.22141/2224-0551.6.74.2016.82139.

42. Flammer A.J., Anderson T., Celermajer D.S., Creager M.A., Deanfield J., Ganz P., Hamburg N.M., Lüscher T.F., Shechter M., Taddei S., Vita J.A., Lerman A. The assessment of endothelial function: from research into clinical practice // Circulation. 2012; 126(6): 753–767. URL: https://doi.org/10.1161/CIRCULATIONAHA.112.093245.

43. Trattner A., David M. Purpuric “gloves and socks” syndrome: histologic, immunofluorescence, and polymerase chain reaction study //j.Am. Acad. Dermatol. 1994; 30: 267–268.

44. Bhattacharyya J., Kumar R., Tyagi S., Kishore J., Mahapatra M., Choudhry V.P. Human parvovirus B19-induced acquired pure amegakaryocytic thrombocytopenia // Br. J. Haematol. 2005; 128: 128–129. URL: https://doi.org/10.1111/j.1365-2141.2004.05252.x.

45. Algwaiz Ghada, Alharbi Abrar, Alsehaim Khuloud. Hematologic manifestations of Parvovirus B 19 infection // Hematol. Oncol. Stem. Cell. Ther. 2023; 16(4): 316–322. URL: https://doi.org/10.56875/2589-0646.1031

46. Srivastava A., Bruno E., Briddell R., Cooper R., Srivastava C., Van Besien K., Hoffman R. Parvovirus B19-induced perturbation of human megakaryocytopoiesis in vitro // Blood. 1990; 76(10): 1997–2004.

47. Kerr J.R. The role of parvovirus B19 in the pathogenesis of autoimmunity and autoimmune disease //j.Clin. Pathol. 2016; 69(4): 279–291. URL: https://doi.org/10.1136/jclinpath-2015-203455.

48. Lunardi C., Tinazzi E., Bason C., Dolcino M., Corrocher R., Puccetti A. Human parvovirus B19 infection and autoimmunity // Autoimmun. Rev. 2008; 8(2): 116–120. URL: https://doi.org/10.1016/j.autrev.2008.07.005.

49. Gharatya A., Nelson Ch., Melath S. Parvovirus B19 infection causing vasculitis and hypocomplementemia // Rheumatology. 2021; 60(1). URL: https://doi.org/10.1093/rheumatology/keab247.031.

50. Lazzerini P.E. Non-HCV-related cryoglobulinemic vasculitis and parvovirus-B19 infection / Lazzerini P.E., Cusi M.G., Selvi E. et al. //joint Bone Spine. 2018; 85(1): 129–130. URL: https://doi.org/10.1016/j.jbspin.2016.12.013.

51. Suzuki M., Watari T. Parvovirus B19 Infection: A Vasculitis Masquerade in an Elderly Patient // Am. J. Case Rep. 2023; 24: e939696. URL: https://doi.org/10.12659/AJCR.939696.

52. Maningding E., Kermani T.A. Mimics of vasculitis // Rheumatology (Oxford). 2021; 60(1): 34–47. URL: https://doi.org/10.1093/rheumatology/keaa495.

53. Hwang H.H., Lim I.S., Choi B.S., Yi D.Y. Analysis of seasonal tendencies in pediatric Henoch-Schönlein purpura and comparison with outbreak of infectious diseases // Medicine (Baltimore). 2018 97(36): e12217. URL: https://doi.org/10.1097/MD.0000000000012217.

54. Atkinson S.R., Barker D.J. Seasonal distribution of Henoch-Schönlein purpura // Br. J. Prev. Soc. Med. 1976; 30(1): 22–25. URL: https://doi.org/10.1136/jech.30.1.22.

55. Felix A., Assad Z., Bidet P., Caseris M., Dumaine C., Faye A., Melki I., Kaguelidou F., Valtuille Z., Ouldali N., Meinzer U. Common Seasonal Pathogens and Epidemiology of HenochSchönlein Purpura Among Children //jAMA Netw. Open. 2024; 7(4): e245362. URL: https://doi.org/10.1001/jamanetworkopen.2024.5362.

56. Heegaard E.D., Taaning E.B. Parvovirus B19 and parvovirus V9 are not associated with Henoch-Schönlein purpura in children // Pediatr. Infect. Dis. J. 2002; 21(1): 31–34. URL: https://doi.org/10.1097/00006454-200201000-00007. PMID: 11791095.

57. Jeanne A. Jordan. Clinical manifestations and diagnosis of parvovirus B19 infection. URL: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-ofparvovirus-b19-infection?search=Clinical%20manifestations%20and%20diagnosis%20of%20parvovirus%20B19%20infection&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1 (дата обращения: 08.08.2024).

58. Morey A.L., Keeling J.W., Porter H.J., Fleming K.A. Clinical and histopathological features of parvovirus B19 infection in the human fetus // Br. J. Obstet Gynaecol. 1992; 99(7): 566–574. URL: https://doi.org/10.1111/j.1471-0528.1992.tb13822.x.

59. Cooper C.L., Choudhri S.H. Photo quiz II. Leukocytoclastic vasculitis secondary to parvovirus B19 infection // Clin. Infect. Dis. 1998; 26(4): 849–989. URL: https://doi.org/10.1086/513955.

60. Veraldi, S. Rizzitelli, G. Henoch-Schönlein Purpura and Human Parvovirus B19 // Dermatology. 1994; 189(2): 213–214. URL: https://doi.org/10.1159/000246839.

61. Schwarz T.F., Bruns R., Schröder C., Wiersbitzky S., Roggendorf M. Human parvovirus B19 infection associated with vascular purpura and vasculitis // Infection. 1989; 17(3): 170–171. URL: https://doi.org/https://doi.org/10.1007/BF01644022.