Abstract
A 72-year-old woman presented with fever, rash and limb pain. Physical examination revealed systemic non-pitting edema, and painful edematous erythema on both forearms and thighs, and non-palpable petechia on her legs. These manifestations were suggestive of papular purpuric gloves and socks syndrome (PPGSS). Her serum anti-parvovirus B19 immunoglobulin M (IgM) was positive. To our knowledge, this is the oldest individual with typical parvovirus 19-associated PPGSS reported to date.
Keywords: Parvovirus B19, Elderly, Papular purpuric gloves and socks syndrome
A 72-year-old woman presented with a 5-day history of fever, rash, and limb pain. She had received clarithromycin from another clinic 3 days previously, with no improvement. She had discontinued the clarithromycin because of the rash which had appeared the next day. Her vital signs were normal other than a body temperature of 37.6 °C. Physical examination revealed systemic non-pitting edema, and painful edematous erythema on both forearms and thighs, and non-palpable petechia on her legs. These manifestations were suggestive of papular purpuric gloves and socks syndrome (PPGSS). Her serum anti-parvovirus B19 immunoglobulin M (IgM) was positive, confirming the diagnosis. She recovered with symptomatic treatment.
Parvovirus B19 infection is well recognized in children as fifth disease or erythema infectiosum. In adults, parvovirus B19 infection has various manifestations and may lead to complications including arthropathy, transient aplastic crisis, myocarditis, and acute glomerulonephritis [1]. Making the correct diagnosis is important because it is sometimes misdiagnosed and treated inappropriately. PPGSS is a type of rash that presents as painful or pruritic edema, erythema, petechia, and purpura of the hands and feet [2]. Although it is reported to be a typical presentation of adult-onset parvovirus B19 infection, there have been few reports of parvovirus B19-associated PPGSS infection in older adults. To our knowledge, this is the oldest individual with typical parvovirus 19-associated PPGSS reported to date (Fig. 1, Fig. 2).
Fig. 1.
(Panel A) Painful and edematous erythema on the patient’s right forearm and back of the hand. There’s a similar findings on the left side.
Fig. 2.
(Panel B) Bilateral non-palpable petechia on the patient’s legs.
Conflicts of interest
There’s no COI in our submission.
Funding
There’s no sources of funding for our submission.
Consent
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
Author contribution
Dr. Y. Nishimura, a corresponding author of this paper have made the design, and wrote whole manuscript.
Dr. T. Ueda, a co-author of this submission, checked and supervised the paper.
We offered Editage (www.editage.com) for English language editing.
References
- 1.Young N., Brown K. Parvovirus B19. N Engl J Med. 2004;350(6):586–597. doi: 10.1056/NEJMra030840. [DOI] [PubMed] [Google Scholar]
- 2.Katta R. Parvovirus B19: a review. Dermatol Clin. 2002;20(2):333–342. doi: 10.1016/s0733-8635(01)00013-4. [DOI] [PubMed] [Google Scholar]