Extra-haematological manifestations related to human parvovirus B19 infection: retrospective study in 25 adults

Dollat, Marion; Chaigne, Benjamin; Cormier, Grégoire; Costedoat-Chalumeau, Nathalie; Lifermann, François; Deroux, Alban; Berthoux, Emilie; Dernis, Emmanuelle; Sené, Thomas; Blaison, Gilles; Lambotte, Olivier; Terrier, Benjamin; Sellam, Jérémie; De Saint-Martin, Luc; Chiche, Laurent; Dupin, Nicolas; Mouthon, Luc

doi:10.1186/s12879-018-3227-1

BMC Infectious Diseases

Table 1 Clinical and biological characteristics, treatment and outcome in 25 patients with extra-haematological manifestations associated with human parvovirus B19 (HPV-B19) infection

From: Extra-haematological manifestations related to human parvovirus B19 infection: retrospective study in 25 adults

N°	Age/ Sex	Type of damage	HPV-B19 markers		CRP, mg/l	Immunological abnormalities	Treatment	Clinical status during follow-up			Residuals symptoms^a	PCR negativation^a/ Time to negativation, months	Follow-up, months
N°	Age/ Sex	Type of damage	IgM/IgG	Blood/TissueDNA				M1	M6	M12	Residuals symptoms^a	PCR negativation^a/ Time to negativation, months	Follow-up, months
1	40/F	Symmetrical polyarthralgia, palpable purpura with subcutaneous nodules	+/+	NP/NP	58	None	None	PR	CR	CR	None	NA/NA	12
2	28/F	Symmetrical polyarthralgia, myalgia, exanthema	+/+	NP/NP	4	None	NSAIDs	PR	CR	CR	None	NA/NA	12
3	24/M	Symmetrical polyarthralgia; exanthema, PPGSS	+/+	NP/NP	< 3	None	CS 1 mg/kg/d	CR	CR	CR	None	NA/NA	12
4	28/M	Symmetrical polyarthralgia	+/+	NP/NP	9	ANA+	None	CR	CR	CR	None	NA/NA	12
5	49/M	Arthromyalgia with axial involvement, elevated liver enzymes	+/+	NP/NP	23	NP	NSAIDs	CR	CR	CR	None	NA/NA	12
6	37/F	Polyarthritis; slapped-cheek rash, hands edema	+/+	NP/NP	21	ANA+, LA+	None	PR	CR	CR	None	NA/NA	12
7	38/F	HLH, acute myopericarditis, pleural effusion; polyarthritis	+/+	+/+(BM)	4	ANA+, RF+, ACPA+, aCL Abs+ (IgG), anti β2GP1 Abs+ (IgG)	NSAIDs, IVIg, CS 10 mg/d, MTX, anti- TNF-α, anti-IL6R	S	S	S	IPPJ synovitis^b	Yes/11	15
8	38/M	Symmetrical polyarthralgia; thighs myalgia	+/+	NP/NP	35	ANA+, anti-dsDNA+, aCL Abs+ (IgG, IgM), C4↓	NSAIDs, HCQ, CS 30 mg/d, MTX	S	PR	PR	Arthralgia	NA/NA	12
9	24/F	Febrile acute polyarthritis with axial involvement	+/+	NP/NP	132	ANA+	NSAIDs	PR	PR	PR	Migratory polyarthragia, asthenia	NA/NA	13
10	38/F	Distal polyarthritis	+/+	+/NP	< 3	ANA+, anti-dsDNA+, C4↓	NSAIDs	PR	PR	–	None	No/NA	9
11	34/F	Polyarthritis; exanthema; asthenia	+/+	NP/NP	114	ANA+, RF+, ANCA+	NSAIDs, CS 0.1 mg/kg/d, MTX, HCQ + NSAIDs	W	S	S	None^b	NA/NA	89
12	32/F	Polyarthritis; exanthema, livedo; hands and feet edema; transient proteinuria	+/+	+/NP	32	None	NSAIDs, colchicine, IVIg, HCQ, myorelaxant, antidepressants	S	S	S	Asthenia, arthromyalgia	Yes/21	48
13	42/F	Polyarthritis, asthenia	+/+	NP/NP	NA	ANA+, anti-dsDNA+, aCL Abs+ (IgG, IgM)	NSAIDs	PR	CR	–	None	NA/NA	6
14	39/F	Cyclical and diffuse arthromyalgia, exanthema	+/+	+/NP	12	None	Antidepressants CS 1 mg/kg	S	S	S	None	Yes/18	25
15	24/F	Polyarthritis, exanthema	+/+	NP/NP	7	ANA+, RF+, ACPA+	NSAIDs, CS 1 mg/kg	PR	CR	CR	None	NA/NA	12
16^c	37/F	Symmetrical and febrile polyarthralgia, calves myalgia	+/+	+/NP	34	RF+, C4↓, abundant mixed cryoglobulin (type II)^d	NSAIDs	PR	CR	–	None	No/NA	6
17	44/M	Nephrotic syndrome, ARF	NA/NA	+/NP	60	NA	Pulsed MP, oral CS 1 mg/kg/d, ACEIs + ARBs, IVIg	W	S	W	Nephrotic syndrome, ESRD	No/NA	23
18	56/F	Febrile polyarthritis; palpable purpura; nephritic syndrome; ARF; asthenia	+/NA	+/NP	31	ANA+, anti-dsDNA+, ANCA+, C4↓	Diuretics, ACEIs	PR	CR	CR	None	NA/NA	30
19	22/F	Acute nephritic syndrome	+/+	NP/NP	17	Anti-dsDNA+, ANCA+, C4↓	Diuretics	PR	CR	CR	None	NA/NA	12
20	37/F	Pure sensory axonal mononeuritis multiplex	−/+	+/NP	< 3	None	CS 1 mg/kg/d, AEDs, IVIg	W	W	PR	Hypoesthesia	No/NA	25
21	42/F	Left ulnar mononeuritis, necrotic purpura with PPGSS	+/+	+/NP	8	ANA+, RF+, cryoglobulin (type III)	CS 20 mg/d, AEDs, IVIg	W	PR	–	Numbness 5th finger	No/NA	7
22	30/F	GBS, polyarthralgia, exanthema, lymphadenopathy	+/−	+/− (CSF)	40	None	IVIg	PR	CR	CR	None	No but ↓↓/NA	18
23	37/F	PPGSS, palpable purpura; symmetrical polyarthralgia	+/+	+/NP	7	None	NSAIDs, CS 1 mg/kg/d	CR	–	–	None	No/NA	4
24	39/M	Palpable purpura & subcutaneous nodules; arthralgia	+/+	−/− (skin)	12	Very low mixed cryoglobulin (type II)	NSAIDs, CS 1 mg/kg/d, colchicine, dapsone	PR	PR	CR	None	NA/NA	13
25	83/F	Asthenia, lymphadenopathy, splenomegaly with spleen infarcts, PPGSS	+/+	-/NP	40	ANA+	None	PR	CR	CR	None	NA/NA	14

^aAt the end of follow-up
^bEvolution towards rheumatoid arthritis, in remission in patient N°11
^cThis case has already been published separately [45]
^dHPV-B19 DNA was more abundant in the cryoprecipitate than in the serum sample
Abbreviations: Abs antibodies, ACEIs angiotensin-converting enzyme inhibitors, aCL anticardiolipin, ACPA anticitrullinated antibodies, AEDs antiepileptic drugs, ANA antinuclear antibodies, ANCA anti-neutrophil cytoplasmic antibodies; anti-dsDNA, anti-double stranded DNA antibodies; anti-IL6R anti-interleukin-6 receptor, anti-TNF-α anti-tumor necrosis factor α, ARBs, angiotensin II receptor antagonists, ARF acute renal failure, BM bone marrow, C4 complement factor 4, CP complete remission, CS corticosteroids, CSF cerebrospinal fluid, d days, w weeks, ESRD end stage renal disease, GBS Guillain-Barré syndrome, HCQ hydroxychloroquine, HLH hemophagocytic lymphohistiocytosis, IVIg intravenous immunoglobulin, LA lupus anticoagulant, MP methylprednisolone, MTX methotrexate, NA not available, NP not performed, NSAIDs nonsteroidal anti-inflammatory drug, PPGSS papular-purpuric gloves and socks syndrome, PR partial remission, RF rheumatoid factor, S stable, W worsening

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