Department of General Internal Medicine, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan.
General Medicine Center, Shimane University Hospital, Izumo, Shimane, Japan.
Am J Case Rep. 2023 Jul 12;24:e939696. doi: 10.12659/AJCR.939696.
BACKGROUND The profound ability of viral infections to convincingly mimic vasculitis, thereby pathologically influencing vessels of any caliber, is undeniably significant. Notably, adult patients with B19V infection frequently experience joint pain and cutaneous eruptions, which are ostensibly immune responses to the infection and necessitate careful differentiation from autoimmunity. Conversely, vasculitis syndromes represent an amalgamation of diseases characterized by vascular inflammation, predominantly classified based on the impacted vessels' size and location. Although the expedited diagnosis and therapeutic management of vasculitis are paramount, many conditions, including infectious diseases, can potentially masquerade as vasculitis, necessitating rigorous differential diagnosis. CASE REPORT A 78-year-old male patient presented with fever, bilateral leg edema, skin rash, and foot numbness to the outpatient department. Blood investigations showed elevated inflammatory parameters, and urinalysis showed proteinuria and occult blood presence. We considered SVV, particularly microscopic polyangiitis, which causes acute renal injury, as the provisional diagnosis. Blood investigations, including auto-antibodies and a skin biopsy, were performed. However, his clinical symptoms resolved spontaneously before these investigation results were reported. Subsequently, the patient was diagnosed with B19V infection based on B19V immunoglobulin M antibody positivity. CONCLUSIONS B19V infection mimics vasculitis. Even in geriatric patients, particularly during B19V infection outbreaks, clinicians should conduct thorough interviews and examinations while contemplating the likelihood of B19V infection as a potential vasculitis mimic.
病毒感染具有令人信服地模拟血管炎的强大能力,从而在病理上影响任何口径的血管,这是不可否认的。值得注意的是,B19V 感染的成年患者常出现关节痛和皮疹,这些显然是对感染的免疫反应,需要与自身免疫仔细区分。相反,血管炎综合征是一组以血管炎症为特征的疾病的综合,主要根据受影响血管的大小和位置进行分类。尽管血管炎的快速诊断和治疗管理至关重要,但许多疾病,包括传染病,都可能伪装成血管炎,需要严格的鉴别诊断。
一名 78 岁男性患者因发热、双侧腿部水肿、皮疹和足部麻木到门诊就诊。血液检查显示炎症参数升高,尿液分析显示蛋白尿和潜血。我们考虑到 SVV,特别是显微镜下多血管炎,会导致急性肾损伤,作为暂定诊断。进行了血液检查,包括自身抗体和皮肤活检。然而,在这些检查结果报告之前,他的临床症状自行缓解。随后,根据 B19V 免疫球蛋白 M 抗体阳性,该患者被诊断为 B19V 感染。
B19V 感染可模拟血管炎。即使是老年患者,特别是在 B19V 感染爆发期间,临床医生在考虑 B19V 感染作为潜在血管炎模拟物的可能性时,应进行彻底的访谈和检查。