Four rash patterns common in adults with parvovirus infection

Image: PD/CDC

1. Parvovirus B19 infection is rare in adults, but can produce a cutaneous rash as seen in children. This rash can be classified into four main patterns: exanthema, vasculitis, periflexural, and acral. More than one pattern can occur in the same individual.  

2. The rash’s appearance, taken together with the rest of the clinical picture, may be used to identify Parvovirus B19 infection in adults. 

Evidence Rating Level: 2 (Good)

Study Rundown: Parvovirus B19 is a common virus worldwide, best known for causing rash and fever in young children. Most people develop antibodies to the virus by adulthood, so symptoms (indicating a primary infection) are rare in adults. Prior studies have established that rash, fever, edema, arthralgia, and myalgia are common, but the nature of the rash in adults is not well characterized. This study examined the rash that occurred in 29 adults with antibody confirmed infection, finding that it occurs in 4 main patterns: exanthema, vasculitis, periflexural, and acral. A high degree of overlap was found between the patterns. In assessing patients from seven tertiary care centers, the study is strengthened by its large breadth, but in not including primary care centers, it may be limited by a sampling bias.

Click to read the study in JAAD

Relevant reading: Mechanisms of Disease: Parvovirus B19

In-Depth [retrospective cohort]: The authors conducted a retrospective analysis of the cutaneous features of 29 patients (17 women and 12 men spanning ages 18 to 89) with a primary Parvovirus B19 infection. Two staff dermatologists reviewed medical records between 1992 and 2013 at seven tertiary care centers and selected patients based on presenting symptoms of fever and rash and laboratory data of positive anti-Parvovirus IgM antibody. Patients with anti-Parvovirus IgG antibody were considered to have had a primary infection in the past and were excluded. Rash most frequently took the form of erythema and purpura, with a few cases of vesicles and pustules. It was most often located on the legs, trunk, arms, and face and accompanied by pruritus in about half of the cases. Four principal rash patterns were identified, with 62% of patients exhibiting more than one: exanthema, resembling erythema infectiosum seen in children  (79%), acral, covering the hands and feet in a sock-and-glove distribution (24%), periflexural, located around the flexures such as the axillae and inguinal folds (28%), and vasculitis, a nonspecific purpuric infiltrate (24%). This data was consistent with published case reports describing all four aforementioned rash patterns.

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