Tanimura Jun, Terakawa Ion
Department of Neurology, Aizawa Hospital, Matsumoto, JPN.
Department of General Internal Medicine, Aizawa Hospital, Matsumoto, JPN.
Cureus. 2023 Aug 22;15(8):e43925. doi: 10.7759/cureus.43925. eCollection 2023 Aug.
Parvovirus B19 infection typically exhibits a biphasic clinical course with varied symptoms. While facial or extremity edemas are common in adult cases, localized eyelid swelling, referred to as Hoagland's sign, had not been recognized as a potential clinical feature. Here, we present the case of a 72-year-old woman with parvovirus B19 infection and Hoagland's sign, characterized by drooping of the swollen upper eyelid and narrowing of the ocular aperture. The patient showed symptoms of fever, myalgia, and neutrophilia with atypical lymphocytes. The diagnosis was confirmed through elevated parvovirus B19 IgM antibody levels. This is the first reported case of parvovirus B19 infection presenting with Hoagland's sign. Parvovirus B19 infection can present with the condition called "infectious mononucleosis-like syndrome" (IML), which mimics classical manifestations of infectious mononucleosis (IM), including Hoagland's sign. Our case suggested that Hoagland's sign may be one of the characteristic symptoms of the second phase in the biphasic course of parvovirus B19 infection. It is important to consider the possibility of parvovirus B19 infection, especially in elderly patients presenting with Hoagland's sign.
细小病毒B19感染通常呈现出具有多种症状的双相临床病程。虽然面部或四肢水肿在成人病例中很常见，但局部眼睑肿胀，即所谓的霍格兰氏征，尚未被认为是一种潜在的临床特征。在此，我们报告一例72岁女性感染细小病毒B19并出现霍格兰氏征的病例，其特征为肿胀的上睑下垂和睑裂缩小。患者出现发热、肌痛症状，伴有中性粒细胞增多及非典型淋巴细胞。通过细小病毒B19 IgM抗体水平升高确诊。这是首例报告的伴有霍格兰氏征的细小病毒B19感染病例。细小病毒B19感染可表现为“传染性单核细胞增多症样综合征”（IML），它模仿传染性单核细胞增多症（IM）的典型表现，包括霍格兰氏征。我们的病例表明，霍格兰氏征可能是细小病毒B19感染双相病程第二阶段的特征性症状之一。尤其对于出现霍格兰氏征的老年患者，考虑细小病毒B19感染的可能性很重要。
