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Özlü SG, Alan B, Şahiner A, Bulut B, Bayhan Gİ, Özdemir Sİ. Parvovirus B19 infection mimicking systemic lupus erythematosus, successfully treated with intravenous immune globulin. Germs 2020; 10:244-248. [PMID: 33134203 DOI: 10.18683/germs.2020.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/03/2020] [Accepted: 06/05/2020] [Indexed: 11/08/2022]
Abstract
Introduction Parvovirus B19 infection generally presents as a transient viral illness in children but rarely shows systemic lupus erythematosus-like symptoms. Case report Here we present a 7-year-old girl with parvovirus B19 infection who had prolonged fever, rash, pancytopenia and hypocomplementemia making it difficult do differentiate from the first episode of systemic lupus erythematosus. Because she had severe progressive pancytopenia she was administered intravenous immune globulin treatment and her clinical course was dramatically improved. Discussion Parvovirus B19 infection can mimic systemic lupus erythematosus and it may be difficult to differentiate a recent parvovirus B19 infection and the first presentation of systemic lupus erythematosus. Absence of discoid lesions, alopecia, Raynaud phenomenon and autoimmune hemolytic anemia may help to distinguish parvovirus B19 infection from systemic lupus erythematosus. Conclusions Parvovirus B19 infection may cause a severe clinical picture resembling systemic lupus erythematosus even in otherwise healthy children. Intravenous immune globulin treatment might be considered in cases resistant to supportive management.
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Affiliation(s)
- Sare Gülfem Özlü
- MD, Associate Professor, Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of Pediatric Nephrology, Yenimahalle Training and Research Hospital, Yeni Batı Mah., 2026. Caddesi, 2367 Sokak No:4, 06370 Batıkent/Yenimahalle/Ankara, Turkey
| | - Başak Alan
- MD, General Pediatrics Residency, Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of General Pediatrics, Kızılırmak Mahallesi, 1436.Sokak, Muhsin Yazıcıoğlu Caddesi, Başak Apartmanı, No:2 /26, Çukurambar, Ankara, Turkey
| | - Aysegül Şahiner
- MD, General Pediatrics Specialist, Ankara Yildirim Beyazıt University, Faculty of Medicine, Yenimahalle Training and Research Hospital, Department of General Pediatrics, İnönü Mahallesi, 1794. Sokak, Özmen Park sitesi, No:8 B Blok, Yenimahalle, Ankara, Turkey
| | - Büşra Bulut
- MD, General Pediatrics Residency, Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of General Pediatrics, Yenibatı Mahallesi, 2413. Sokak, No:6 Kat:3 Batıkent, Yenimahalle, Ankara, Turkey
| | - Gülsüm İclal Bayhan
- MD, Associate Professor, Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Mahmut Esat Bozkurt Caddesi, No: 12/3 Çankaya, Ankara, Turkey
| | - Sonay İncesoy Özdemir
- MD, Associate Professor, Ankara Yildirim Beyazıt University, Faculty of Medicine, Department of Pediatric Oncology, Söğütbeli Caddesi, Alya Sitesi, No: 4/10, Etlik, Ankara, Turkey
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Fujii T, Iwabuchi Y, Moriyama T, Uchida K, Nitta K. A case of Lemierre syndrome combined with a suspected systemic lupus erythematosus flare. SAGE Open Med Case Rep 2019; 7:2050313X19871782. [PMID: 31489196 PMCID: PMC6709436 DOI: 10.1177/2050313x19871782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/01/2019] [Indexed: 11/16/2022] Open
Abstract
Lemierre syndrome develops in healthy young patients as a result of bacteremia
after oral cavity infection. It causes thrombophlebitis in the internal jugular
vein. Infection can easily occur during immunosuppressive treatment in patients
with systemic lupus erythematosus and become severe. We present a case of
Lemierre syndrome in a patient with systemic lupus erythematosus. A 56-year-old
woman presented with fever, left lower toothache, and skin symptoms from the
left neck to the anterior chest. Clinical presentation and laboratory
investigations revealed Lemierre syndrome. The inflammation and thrombus
disappeared with antibiotic and anticoagulant therapies. However, transient
hypocomplementemia and elevated antinuclear antibody levels were observed during
treatment; therefore, a concomitant systemic lupus erythematosus flare was
considered. In systemic lupus erythematosus patients with Lemierre syndrome,
complement and antinuclear antibody levels are modified, so other indicators
should be precisely evaluated, such as levels of urinary protein, sediment,
serum creatinine and anti-dsDNA antibody, and systemic lupus erythematosus
disease activity index.
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Affiliation(s)
- Teruhiro Fujii
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuko Iwabuchi
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahito Moriyama
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiko Uchida
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kosaku Nitta
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
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Shin H, Park S, Lee GW, Koh EH, Kim HY. Parvovirus B19 infection presenting with neutropenia and thrombocytopenia: Three case reports. Medicine (Baltimore) 2019; 98:e16993. [PMID: 31464949 PMCID: PMC6736112 DOI: 10.1097/md.0000000000016993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Parvovirus B19 (PV) infection is usually symptomless and can cause benign, short-lived conditions. Anemia associated with PRCA is the most representative hematologic manifestation, but neutropenia and thrombocytopenia have been rarely reported. PATIENT CONCERNS Three patients were admitted to the hospital with neutropenia and thrombocytopenia. The accompanying symptoms were fever, myalgia, rash, or arthralgia, and all patients were previously healthy. DIAGNOSIS Patients were positive for PV PCR and diagnosed with PV infection. Before the diagnosis of PV infection, 2 patients underwent BM study and almost absence of erythroid progenitor cells in BM aspiration were a clue for the PV infection. Other BM findings were hypocellular marrow and a few hemophagocytic histiocytes. INTERVENTIONS Patients received supportive care with follow-up of CBC. OUTCOMES All 3 patients spontaneously recovered from neutropenia and thrombocytopenia within 3 weeks without severe complications. LESSONS The evaluation of PV infection should be considered in situations where there is neutropenia and thrombocytopenia in healthy individuals even without anemia as a differential diagnosis.
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Affiliation(s)
| | - Sungwoo Park
- Division of Hematology-Oncology, Department of Internal Medicine Gyeongsang National University Hospital, Gyeongsang National University School of Medicine
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine Gyeongsang National University Hospital, Gyeongsang National University School of Medicine
- Institute of Health Science, Gyeongsang National University, Jinju
| | - Eun-Ha Koh
- Department of Laboratory Medicine
- Institute of Health Science, Gyeongsang National University, Jinju
| | - Hyun-Young Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Mira FS, Marques D, Sousa V, Nogueira C, Garcia R, Alves R. Parvoviral infection with systemic impact and renal consequences. BMJ Case Rep 2019; 12:12/6/e229622. [PMID: 31177196 DOI: 10.1136/bcr-2019-229622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Parvovirus infection is usually asymptomatic especially in immunocompetent adults. When symptomatic it can range from mild to life threatening depending on the patient's age and comorbidities. We report a case of a 40-year-old male patient with parvovirus infection who presented a purpuric rash in distal extremities, acute kidney injury, type II mixed cryoglobulinaemia and hypocomplementaemia. His renal biopsy showed a mesangioproliferative glomerulonephritis with positive immunoreactivity to C3, IgM and C1q. Parvovirus B19 was detected in the biopsy tissue by PCR. He was treated with prednisolone with total remission after 1 month. We discuss the diagnosis of kidney lesion due to parvovirus in an immunocompetent person, which is a very rare condition and its association with the cryoglobulinaemia diagnosis.
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Affiliation(s)
- Filipe Santos Mira
- Nephrology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Medical Sciences, Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal
| | - Daniel Marques
- Medical Sciences, Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal.,Internal Medicine, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Vítor Sousa
- Anatomical Pathology, Coimbra's Medical College, Coimbra, Portugal.,Anatomical Pathology, Coimbra's Hospital and Universitary Center, Coimbra, Portugal
| | - Célia Nogueira
- Anatomical Pathology and Molecular Pathology Institute, Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal.,Center for Neuroscience and Cell Biology, Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal
| | - Rui Garcia
- Medical Sciences, Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal.,Internal Medicine, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Rui Alves
- Nephrology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Medical Sciences, Universidade de Coimbra Faculdade de Medicina, Coimbra, Portugal
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Hashizume H, Kageyama R. Hypocomplementemia is a diagnostic clue for parvovirus B19 infection in adults. J Dermatol 2016; 44:e27. [PMID: 27238731 DOI: 10.1111/1346-8138.13469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Hideo Hashizume
- Department of Dermatology, Shimada Municipal Hospital, Shimada, Japan
| | - Reiko Kageyama
- Department of Dermatology, Shimada Municipal Hospital, Shimada, Japan
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem organ involvement, heterogeneity of clinical features, and variety in degree of severity. The differential diagnosis is a crucial aspect in SLE as many other autoimmune diseases portray clinical similarities and autoantibody positivity. Lupus mimickers refer to a group of conditions that exhibit both clinical features and laboratory characteristics, including autoantibody profiles that resemble those present in patients with SLE, and prompt a diagnostic challenge in everyday clinical practice. Thus, lupus mimickers may present as a lupus-like condition (i.e., 2 or 3 criteria) or as one meeting the classification criteria for SLE. Herein we review and classify the current literature on lupus mimickers based on diverse etiologies which include infections, malign and benign neoplasms, medications, and vaccine-related reactions.
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Affiliation(s)
- Omar-Javier Calixto
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Juan-Sebastian Franco
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia.
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Shimohata H, Higuchi T, Ogawa Y, Fujita S, Nagai M, Imaizumi M, Maruyama H, Hirayama K, Kobayashi M. Human Parvovirus B19-Induced Acute Glomerulonephritis: A Case Report. Ren Fail 2012; 35:159-62. [DOI: 10.3109/0886022x.2012.736068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sugimoto T, Tsuda A, Uzu T, Kashiwagi A. Emerging lupus-like manifestations in acute parvovirus B19 infection. Clin Rheumatol 2007; 27:119-20. [PMID: 17622480 DOI: 10.1007/s10067-007-0691-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 06/19/2007] [Indexed: 11/29/2022]
Abstract
We encountered an adult patient with acute parvovirus B19 infection who presented with transient lupus-like symptoms (i.e., polyarthritis, fever, myalgia, pancytopenia, hypocomplementemia, and nephritis). Our case is characterized by the demonstration of acute nephritis as a complication of this infection, making it difficult to distinguish between a viral infection and the first episode of systemic lupus erythematosus.
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Affiliation(s)
- Toshiro Sugimoto
- Department of Internal Medicine, Shiga University of Medical Science, Seta, Otsu, Shiga, 520-2192, Japan.
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