An Adult Case of Human Parvovirus B19 Infection Mimicking Rheumatoid Arthritis with Purpura on Lower Extremities and a High Serum Level of Rheumatoid Factor

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  • NAKAMURA Akiko
    Department of Dermatology, Yamaguchi University Graduate School of Medicine
  • NAKAMURA Yoshitaka
    Department of Dermatology, Yamaguchi University Graduate School of Medicine
  • MATSUMOTO Kishiko
    Department of Dermatology, Yamaguchi University Graduate School of Medicine
  • KURATA Yusuke
    Department of Dermatology, Yamaguchi University Graduate School of Medicine
  • MUTO Masahiko
    Department of Dermatology, Yamaguchi University Graduate School of Medicine

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Other Title
  • リウマトイド因子が高値で関節リウマチ様症状を呈し下肢に紫斑を生じた成人ヒトパルボウイルス B19 感染症の 1 例
  • 症例 リウマトイド因子が高値で関節リウマチ様症状を呈し下肢に紫斑を生じた成人ヒトパルボウイルスB19感染症の1例
  • ショウレイ リウマトイド インシ ガ タカネ デ カンセツ リウマチ ヨウ ショウジョウ オ テイシ カシ ニ シハン オ ショウジタ セイジン ヒトパルボウイルス B19 カンセンショウ ノ 1レイ

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A 54-year-old Japanese woman presented with purpuric eruptions on both legs, associated with arthralgia and swelling of wrist, knees, and ankles bilaterally. The patient's temperature was 38.3 ℃ and laboratory investigations identified a raised erythrocyte sedimentation rate and a C-reactive protein level of 2.53 mg/dl, an increased serum rheumatoid factor (RF) level of 632.9 U/ml, and a decreased CH50 level of 25.3 U/ml. Histopathological examination of a skin biopsy from the purpuric lesion of the right lower leg revealed a perivascular neutrophil dominant inflammatory cell infiltration with leukocytoclasis, red blood cell extravasation, and fibrinoid degeneration of the small vessel walls in the upper and middle dermis, consistent with leukocytoclastic vasculitis. Rheumatoid arthritis (RA) was initially suspected, but we diagnosed our patient as human parvovirus B19 (HPaV-B19) infection from the result of a positive serum HPaV-B19 IgM antibodies level of 8.84. The symptoms of pyrexia, arthralgia, and skin lesions were resolved in 12 days with supportive measures. Recurrence was not observed thereafter, although her raised serum RF level has remained positive. HPaV-B19 infection should be kept in mind as a differential diagnosis in an adult case presenting with RA-like symptoms and atypical eruptions.

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