Poster 5: A Case of Parvovirus-B19 (Fifth Disease) Adult Acute Arthralgia: A Case Report

Article Outline

• Disclosures
• Patients or Programs
• Program Description
• Setting
• Results
• Discussion
• Conclusions
• Copyright

Keywords: Rehabilitation, Parvovirus, Arthritis

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Disclosures 

D. A. Venesy, Cleveland Clinic, Employment.

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Patients or Programs 

A 39-year-old woman with acute polyarthralgia from a viral infection (parvovirus B19).

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Program Description 

A 39-year-old woman suddenly developed acute arthralgias involving her knees, ankles, wrists and metacarpal joints about 1 month after treatment for strep throat. She was afebrile and had no rashes. She recalled that her 4-year-old son had “slapped cheeks,” a few days prior to the onset of her acute arthritis. Parvovirus B-19 serology was positive. Joint symptoms and swelling resolved within 2 weeks. The presentation of an acute virus infection, Parvovirus B-19 or Fifth Disease, causing acute arthralgia in adults is discussed.

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Setting 

Tertiary outpatient clinic.

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Results 

Six days after onset of acute arthralgia, she was evaluated, including lab work. Complete metabolic profile was normal; CBC showed hgb 11.7, hct 34.5, WBC 5.7; differential showed 72.8 neutrophils (nl 40-70), 17.8 lymphocytes (nl 22-44). WSR was elevated (53, nl 0-20); CRP was 1.5 (nl 0-2.0). Strep antibodies were elevated: 265 (nl 0-125). Viral antibodies were obtained 2 days later, and were positive: Parvovirus B19 IgG was 77 (nl < 10), and Parvovirus B19 IgM was 67 (nl <10). ∼4 years later, normal ANA level, 1.2 (nl < 1.5); normal microsomal antibody, <3.0 (nl <5.0); normal TSH, 1.9 (nl 0.4-5.5); normal CBC.

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Discussion 

Parvovirus B-19 infection is common in children ages 4-11 y. About half of these infections are asymptomatic. In adults, parvovirus B-19 associated arthritis is often polyarticular and symmetric; facial rash is rarely noted. There are reports that adult parvovirus P-19 infections may be linked to neuropathies, vasculitides, and one case of allergic disease. Our patient has been followed up for over 6 years, and she has not developed any other rheumatologic disorders or vasculitis.

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Conclusions 

Physiatrists should be aware of rheumatologic complaints related to viral infections such as parvovirus, chronic hepatitis B and hepatitis C infections. The arthritic presentation is nonspecific. Parvovirus B-19 related arthropathy occurs in 60% of adult patients; it is rare in children; it is usually temporary as described in our patient, but it may last for years.