On follow up, in the first month after discharge she was symptom-free and match C3 and C4 levels had returned to normal. Discussion There are several reports in adults describing lupus-like features and multisystemic involvements in PVB19 infection but these manifestations are relatively rare in children.1,2 Here we presented a 7-year-old woman diagnosed with PVB19 illness mimicking the clinical course of SLE. may help to distinguish parvovirus B19 illness from systemic lupus erythematosus. Conclusions Parvovirus B19 illness may cause a severe medical picture resembling systemic lupus erythematosus actually in normally healthy children. Intravenous immune globulin treatment might be regarded as in instances resistant to supportive management. strong class=”kwd-title” Keywords: Parvovirus B19, systemic lupus erythematosus, children Intro Parvovirus B19 (PVB19) infections are associated with a wide spectrum of disease and the most common clinical programs in child years are erythema infectiosum and aplastic problems in chronic hemolytic anemias.1 Adults, especially women, frequently experience arthropathy and there are several case reports documenting the association between PVB19 and various rheumatic diseases.1,2 Similarities between systemic lupus erythematosus and PVB19 illness have also been reported.2,3 Additionally, hypocomplementemia without additional clinical features of lupus and multisystemic involvement are reported in adults, but these are much rarer in children.4 Here we statement a 7-year-old woman with PVB19 infection mimicking systemic lupus erythematosus (SLE), successfully treated with intravenous immune globulin (IVIg) administration. Case statement A previously healthy 7-year-old girl went to her family physician with fever and sore throat enduring for four days and was started on amoxicillin clavulanic acid treatment having a analysis of acute tonsillitis. She was then referred to our hospital because of the prolonged fever and maculopapular rash on the second day time of treatment. At admission physical examination exposed fever (39C, axillary) and maculopapular rash involving the whole trunk, extremities and face. The rash was more prominent on extremities (Number 1). Open in a separate window Number 1 Maculopapular rash involving the trunk and top extremities The oropharynx was hyperemic. Enlarged and painful lymph nodes were recognized in the submandibular region. Additional systemic examinations were normal. On laboratory examination, white blood cell (WBC) count was 6450/mm3, hemoglobin was 11 g/dL and platelet count was 119000/mm3. Urine exam was normal. Acute phase reactants were mildly elevated; erythrocyte sedimentation rate (ESR) Glycitein was 37 mm/hour, C reactive protein (CRP) was 5.6 mg/dL (0-0.5 mg/dL). Serum blood urea nitrogen (BUN), creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), glucose, potassium, magnesium, phosphorus were all in normal range. She experienced slight hyponatremia (131 mEq/L; normal range: 135-145 mEq/L) and hypoalbuminemia (2.87 g/dL; normal 3.5 g/dL). Chest X-ray was normal. Urine, throat and blood ethnicities were all sterile. Because the rash experienced developed after amoxicillin clavulanate exposure, in the first place it was attributed to drug eruption so antimicrobial therapy was switched to clarithromycin. She was still febrile on the third day time of hospital admission and rash still persisted. The living of rash did not correlate with the degree of fever, it was constant and did not respond to antihistaminic medicines. Reevaluating her physical exam exposed hepatosplenomegaly. In repeated laboratory examinations, markedly elevated CRP and ESR, leukopenia, thrombocytopenia and slight anemia were recognized; Coombs test was negative. Liver enzymes were mildly elevated as ALT 68 U/L (0-50) and AST 97 U/L (15-60); fibrinogen, ferritin, triglyceride and LDH were all in normal limits. Although all repeated tradition samples were sterile, she was started on broad spectrum antibiotics considering the possibility of bacterial sepsis. Abdominal ultrasonography was normal except for hepatosplenomegaly. Echocardiography was normal, there was no coronary artery aneurysm or any additional finding suggesting Kawasaki disease. The multisystemic nature of the disease program prompted us to Glycitein consider connective cells disorders such as SLE or systemic juvenile idiopathic arthritis. She experienced a very low match C4 level as 0.003 g/L (normal range 0.13-0.46 g/L), and slightly low match C3 level while 0.67 g/L; (normal range 0.82-1.73 g/L). Serum antinuclear antibody (ANA) and anti-double stranded DNA (anti-dsDNA) were negative, also clinically she did not possess discoid lesions or alopecia, and she did not possess a history of Raynaud trend; HPTA so SLE was thought to be unlikely. The distribution of the rash was not associated with the peaks of fever and the duration of the symptoms was less than 2 weeks therefore systemic joint disease was also excluded. Because she acquired pancytopenia, rash and fever in the seventh time of Glycitein her symptoms, viral attacks such as for Glycitein example measles, rubella, EBV, PVB19 and CMV were investigated. Among them, particular antibodies to PVB19 IgM.
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