Human parvovirus B19 infection: Its relationship with systemic lupus erythematosus

Objectives: The clinical presentation and outcome of four cases of human pa rvovirus-B19 (HPV-B19) infection, initially diagnosed as systemic lupus ery thematosus (SLE), were reviewed and compared with similar cases previously reported in the literature. The relationship between HPV-B19 infection and SLE is discussed, Methods: The medical records of four patients with documented HPV-B19 infec tion, initially diagnosed as SLE, were reviewed and studied in detail. A Me dline search from 1985 to 1997 was performed to identify other cases report ed in the literature in which a relationship between HPV-B19 and SLE had be en identified in both adults and children. Results: In all of our cases, the clinical findings (fever, rash, arthritis and malaise) and hematologic data (leukopenia, thrombocytopenia, anemia, p resence of autoantibodies, hypocomplementemia, etc.) had initially suggeste d a diagnosis of juvenile SLE. Subsequently, evidence of HPV-B19 infection at the time of clinical presentation was ascertained. In three of these cas es, the disease course was self-limiting with complete clinical remission a nd normalization of hematologic abnormalities within 18 months; one case, h owever had persistent disease activity and repeated exacerbations. Conclusions: The occurrence of HPV-B19 infection has been documented in pat ients with SLE, in particular in relation to disease onset. Similarities in clinical and immunological features of viral infections and SLE at present ation may hinder the differential diagnosis between these two conditions. T he family history, a self-limiting disease course and certain disease speci fic clinical aspects may help the pediatrician formulate an accurate diagno sis. In our patients, HPV-B19 infection may have mimicked the onset of SLE in three cases, but triggered the disease in one. Semin Arthritis Rheum 28: 319-325. Copyright, (C) 1999 by W.B. Saunders Company.