Parvovirus B19 Infection

Author:
Randi Flexner, DNP, APN-C, RN
Clinical Assistant Professor, School of Nursing, Rutgers, the State University of New Jersey, Blackwood, New Jersey

Citation:
Flexner R. Parvovirus B19 infection. Consultant. 2019;59(8):252-254.

A 55-year-old white woman presented with new-onset acute bilateral hand swelling and numbness, upper-limb motor weakness, generalized fatigue, bilateral popliteal inflammation, and a transient episode of left-sided jaw tetany with spontaneous resolution.

At presentation, the patient was afebrile, with no reported chest pain or dyspnea. She reported having been in relatively good health before the onset of symptoms 5 days previously. While waiting for an appointment with a rheumatologist, she had been self-treating with oral ibuprofen (600 mg), applying heating pads to her arms, and wearing cock-up wrist splints during sleep in an effort to decrease the bilateral numbness of her hands.

Her current medications were as follows: amlodipine, 10 mg daily; hydrochlorothiazide/triamterene (25 mg/37.5 mg), 1 capsule daily; levothyroxine, 125 µg daily; vitamin D, 2000 IU daily; and metformin, 850 mg twice daily. The metformin had been newly prescribed 2 weeks prior by an endocrinologist for an elevated hemoglobin A1c level and metabolic syndrome.

Her medical history included controlled hypertension and hypothyroidism (Hashimoto thyroiditis), and she was overweight, with body mass index of 29 kg/m2. She had a 30-year history of antinuclear antibody (ANA) positivity, diagnosed at age 22 years. She had had a full rheumatology workup at that time and had had annual rheumatologic follow-up visits for 2 decades, during which time she had had 3 uncomplicated pregnancies, then had been discharged from rheumatologic care, since no signs or symptoms of systemic lupus erythematous had been evident.

Physical examination revealed bilateral inflammation of the digits and the metatarsal region (Figure 1). The patient was unable to perform gross or fine motor skills with an inability to make a fist or grasp items. The bilateral deltoid muscles appeared swollen and tender to palpation. She was unable to extend her arms more than 30°. Periorbital swelling was present (Figure 2).

   
Figure 1. The patient’s hand showing swelling at presentation (left) compared with a previous photograph of the hand at baseline (right).

   
Figure 2. Periorbital swelling at presentation.