Generalised edema with human parvovirus B19 infection

• Published in: BMJ case reports 2021-07, Vol.14 (7), p.e243130
• Main Authors: Hayano, Satoshi, Oshikawa, Hideto
• Format: Article
• Language: English
• Subjects: Case reports; Edema; Edema - etiology; Erythema Infectiosum - complications; Erythema Infectiosum - diagnosis; Female; Heart failure; Humans; Images In; Infections; Laboratories; Parvoviridae Infections - complications; Parvoviridae Infections - diagnosis; Parvovirus B19, Human; Pleural effusion; Pregnancy; Pregnancy Complications, Infectious; Thyroid gland
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-243130

The results of the initial laboratory tests were as follows: leucocyte count, 4.63×109/ L; haemoglobin, 100g/L; red blood cell count, 3.14×1012/ L; mean corpuscular volume, 98.1 fL; platelet count, 222×109/ L; serum creatinine, 1.02 mg/dL; blood urea nitrogen, 18.4 mg/dL; total-bilirubin, 0.5 mg/dL; aspartate aminotransferase, 38 U/L; alanine aminotransferase, 47 U/L; serum lactate dehydrogenase, 280 U/L; free T4, 1.05 ng/dL; thyroid-stimulating hormone, 0.90 μIU/mL; serum albumin, 3.0 g/dL and C reactive protein, 0.24 mg/dL. B19V infection in immunocompetent adults often presents with arthralgia, and typical facial rash with slapped-cheek appearance is rare.1 There were few reports of generalised oedema in adults.1–4 This case did not occur during an epidemic of B19V, however, it has been reported that generalised oedema were often observed during the B19V epidemic.4 Compared with B19V-induced fetal hydrops, cardiac failure and hemolysis are unlikely to be the cause of oedema in adults. The presentation of generalised oedema suggests a capillary leak syndrome-like mechanism, but the aetiology remains to be elucidated.1 The time from onset to appearance of oedema is often delayed (4–13 days), with a weight gain of 2.5–7 kg.4 In general, the prevalence of B19V-specific antibodies increases with age, however, it has been reported that about half of women of childbearing age was negative for human parvovirus IgG.5 6 B19V infection should be considered as a differential diagnosis of acute pitting oedema especially in susceptible adults with a recent history of infection.