Engel F, Maradeix S, Braun-Parvez L, Lipsker D, Cribier B
Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg.
Ann Dermatol Venereol. 2007 Feb;134(2):160-3. doi: 10.1016/s0151-9638(07)91610-5.
Leukocytoclastic vasculitis following Parvovirus B19 primary infection has occasionally been reported in children but it occurs rarely in adults. We present an original case report with severe renal complications.
A 33-year-old man presented with fever and eruption of the abdomen and members. Papules and vesiculopustules were associated with oral and genital ulcerations. These lesions subsequently became purpuric and necrotic. Histological analysis confirmed the diagnosis of pustulous leukocytoclastic vasculitis with IgA deposits. Laboratory investigations showed elevated sedimentation rate, hepatic cytolysis and renal impairment (hematuria, leucocyturia and proteinuria 1.5 g/24 hours). Anti-parvovirus B19 IgM were positive. Three months after the eruption resolved, IgM were undetectable while anti-parvovirus B19 IgG appeared. Renal injury progressively worsened: elevation of proteinuria (5 g/24 hours) and diminution of creatinine clearance (51 ml/min). Renal biopsy showed glomerulonephritis with mesangial IgA deposits. Major proteinuria persisted one year after the disappearance of dermatological lesions in spite of ACE inhibitor treatment.
The role of Parvovirus B19 has been suspected as an aetiological agent in many kinds of vasculitis, e.g. polyarteritis nodosa, Wegener's disease and leucocytoclastic vasculitis. In this case report, the detection of specific IgM and the absence of other factors associated with vasculitis are consistent with a causal role of Parvovirus B19. In previously published cases, the prognosis of parvovirus B19-associated vasculitis does not seem to differ from that of idiopathic vasculitis. To our knowledge, this is the first case exhibiting concomitant and persistent severe renal involvement.
细小病毒B19原发性感染后发生的白细胞破碎性血管炎在儿童中偶尔有报道，但在成人中很少见。我们报告一例伴有严重肾脏并发症的原始病例。
一名33岁男性，出现发热及腹部和四肢皮疹。丘疹和水疱脓疱伴有口腔和生殖器溃疡。这些皮损随后变为紫癜性和坏死性。组织学分析确诊为伴有IgA沉积的脓疱性白细胞破碎性血管炎。实验室检查显示血沉升高、肝细胞溶解和肾功能损害（血尿、白细胞尿和蛋白尿1.5g/24小时）。抗细小病毒B19 IgM阳性。皮疹消退三个月后，IgM检测不到，而抗细小病毒B19 IgG出现。肾损伤逐渐加重：蛋白尿升高（5g/24小时），肌酐清除率降低（51ml/min）。肾活检显示系膜IgA沉积的肾小球肾炎。尽管使用了血管紧张素转换酶抑制剂治疗，但皮肤病变消失一年后仍有大量蛋白尿。
细小病毒B19的作用在多种血管炎中被怀疑为病因，如结节性多动脉炎、韦格纳肉芽肿病和白细胞破碎性血管炎。在本病例报告中，特异性IgM的检测以及不存在与血管炎相关的其他因素与细小病毒B19的因果作用一致。在先前发表的病例中，细小病毒B19相关血管炎的预后似乎与特发性血管炎无异。据我们所知，这是首例同时出现并持续存在严重肾脏受累的病例。
