Parvovirus B19-associated purpuric–petechial eruption

Abstract

Background Papular-purpuric gloves-and-socks syndrome, characterized by focal acral purpuric eruptions with a symmetrical distribution, is a rare but representative purpuric dermatosis closely associated with parvovirus B19 (PVB19) infection. However, several atypical presentations such as involvement of other sites and generalized involvement have been recently reported in PVB19 infected patients. Such multifaceted features can cause considerable confusion when making a diagnosis of purpuric eruption associated with PVB19. Objectives Describe two febrile patients with atypical presentation of papular-purpuric eruptions due to PVB19 infection and discuss the distinctive features of purpuric–petechial eruptions associated with PVB19 infection. Study design Case reports and viral diagnosis by serologic tests and real-time PCR for PVB19 DNA in the serum. Results One presented with “asymmetrical gloves without socks” distribution of papular purpuric eruptions accompanied by asymmetrical intertriginous involvement, the other with generalized distribution characterized by prominent intertriginous and truncal involvement. Both cases were followed by erythema infectiosum. Paired serum antibody analysis and real-time PCR indicated the link between the development of papular purpuric eruption and the viremic phase of primary PVB19 infection. Conclusions PVB19 infection should be considered in any patient presenting with a petechial or purpuric eruption of unclear origin, and not solely for PPGSS type presentations. Therefore, we propose a simple name “PVB19-associated purpuric–petechial eruption” to describe polymorphous purpuric–petechial eruptions due to PVB19 infection, coinciding with the viremic phase of primary infection and infectivity, characterized by a self-limiting course with a benign prognosis and common histological findings.