Adult Human Parvovirus B19 Infection Presenting as Erythema Multiforme Hypercytokinemia Correlated with Disease Activity

Abstract

A 52-year-old Japanese man developed pharyngalgia and arthralgia at the beginning of April, 2007. He had a high fever and erythema on the legs and trunk and was hospitalized on April 7. Physical examination revealed erythema multiforme-like skin lesions on the legs and trunk, hyperemic conjuntiva palpebrarum, and swelling of the neck lymph nodes. Blood tests showed a normal white blood cell count, reduced number of lymphocytes, highly positive CRP, and a mild abnormality in liver function. Histopathology showed spongiosis in the epidermis and liquefaction degeneration and interface dermatitis in the dermoepidermal junction. Viral tests were positive for IgM anti-human parvovirus B19 antibody, and the patient was treated only for his symptoms. During the disease course, he developed transient atrial fibrillation. In addition to CRP and RAPA, the measurements of IL-6 and IL-8 were useful in assessing the disease activity. In addition to atypical skin lesions, adult human Parvovirus B19 infection shows abnormal general conditions, such as fever and arthralgia and, rarely, myocarditis. We should be careful to look for these complications.