Human Parvovirus B-19 in Adult

Question

I was recently diagnosed with human parvovirus by a rheumatologist. The doctor who ran the test said that he is puzzled and unsure as to why the level of ImG in my blood is still high even though I have had symptoms, which have been worsening, for the past two months. Because the Voltaren originally prescribed for me did not do anything to relieve the pain or swelling, he would like me to start on prednisone. I am concerned because of the amount of fatigue that I have been experiencing and the amount of difficulty I am now having with me hands, wrists, ankles and feet. I would be interested in hearing the thoughts of someone on your staff regarding this virus and the treatments for it.

Answer

Parvovirus B19 is a virus common in school age children particularly at this time of year. In children, it is often called Fifth’s Disease or erythema infectiosum. It presents as a fever and a flat red skin rash on the face “slapped cheeks” and occasionally on the palms and soles of the feet. By the time the rash appears, the child is ususally better and no longer infectious. For the most part, it is relatively a mild infection.

In adults, it can cause an inflammatory arthritis that looks very much like rheumatoid arthritis. Adults often lack the fever and rash. In general the arthritis starts to improve spontaneously by at least 6 weeks, occasionally a little longer. The arthritis can be debilitating and require prednisone to control symptoms. The IgM antibody test diagnoses acute infection, the IgG antibody test diagnoses exposure in the past. The IgM antibody should eventually clear and convert entirely over to IgG antibody. If the arthritis does not get beeter, other types of arthritis should be considered and the positive test for parvovirus IgM repeated.

Alan Matsumoto, M.D.

About Alan Matsumoto, M.D.

Part-time Faculty, Division of Rheumatology
Johns Hopkins University