A Case of Dermatitis Associated with Human Parvovirus B19 and Induced by the Pressure of Wearing Corrective Underwear

Abstract

A 45-year-old woman visited our outpatient clinic with pruritic eruptions on her trunk.Physicalexamination revealed demarcated symmetrical erythema on the lower back and monotonous small red papules on the chest.She affected area matched the sites that were compressed by her corrective bodysuit.Therefore,treatment with topical corticosteroids was initiated under the diagnosis of contact dermatitis.Afterthree days, the rash expanded with emerging purpura and we found that her daughter had erythema infectiosum.Consideringthe differential diagnosis of erythema infectiosum and vasculitis, a skin biopsy and blood tests were performed.Histopathologically,the skin biopsy tissue sections showed interface changes and thickening of endothelial cells, perivascular infiltration by lymphocytes, and nuclear debris in the upper dermis. Extravasation of red blood cells was also noted around small vessels in the upper dermis.Inaddition, atypical lymphocytes (4. 5%) and seropositivity for HPaV-B19 IgM antibody were observed by blood tests.Basedon these pathological findings, we diagnosed the present case as having dermatitis related to HPaV-B19.Itis already known that papular purpuric gloves and socks syndrome (PPGSS), which is caused by HPaV-B19 infection, results in the appearance of specific eruptions on the extremities.Meanwhile,it has been hypothesized that the purpura of PPGSS result from the deposition of immune complex around the vessels, triggered by mechanical stimulation.Weconsidered that the manifestation of our case may be induced by pressure on the skin, and classified it as a type of PPGSS.