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Ahead of print publication
Parvovirus B19 infection simulating a vesicular exanthem associated with COVID-19


1 Department of Dermatology, Lozano Blesa University Clinical Hospital of Zaragoza, Zaragoza, Spain
2 Department of Microbiology, Lozano Blesa University Clinical Hospital of Zaragoza, Zaragoza, Spain

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Date of Submission06-Dec-2020
Date of Decision25-Dec-2020
Date of Acceptance27-Dec-2020
Date of Web Publication22-Apr-2021
 


How to cite this URL:
Garcia-Gil MF, Monte-Serrano J, Pascual-Del-Riquelme AJ, Ara-Martin M. Parvovirus B19 infection simulating a vesicular exanthem associated with COVID-19. Dermatol Sin [Epub ahead of print] [cited 2021 May 7]. Available from: https://www.dermsinica.org/preprintarticle.asp?id=314374




Dear Editor,

COVID-19 patients present with various cutaneous manifestations that are habitual in other viral infections. The vesicular eruption has an appearance similar to varicella and has been described as infrequent but specific to SARS-CoV-2 infection.[1] The differential diagnosis has also been proposed with other pathologies with a similar appearance, such as herpes simplex, herpes zoster, miliaria, impetigo, ecthyma, and coma blisters.[2]

Parvovirus B19 can also produce vesicular exanthems that are very similar to those being reported during the COVID-19 pandemic.[3] We present the case of a child who posed the differential diagnosis of a vesicular exanthema caused by SARS-CoV-2 due to both the symptoms and the epidemiological setting.

An 8-year-old boy presented with a papulovesicular exanthem on the trunk and extremities that had developed over a period of 3 days [Figure 1]. On the 4th day after the onset of skin symptoms, the patient developed a fever, cough, and general malaise. His mother worked as a nurse in a pneumology department and had been in contact with COVID-19 patients. His sister presented with fever and perniosis-like lesions on toes that had developed over 7 days.
Figure 1: (a) Papulovesicular exanthem scattered over the thorax and abdomen. (b) The lesions can be seen as erythematous vesicles and papules of 1–3 mm in diameter, scattered over the surface of the skin.

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Blood tests, which included biochemical, hemogram, coagulation test, and urinalysis, showed no alterations. The serologies for parvovirus B19, Epstein–Barr virus (EBV), cytomegalovirus (CMV), measles, parotitis, rubella, herpes simplex, varicella-zoster, HIV, rickettsiosis, and hepatitis B and C, as well as the polymerase chain reaction (PCR) for enterovirus (coxsackievirus, poliovirus, and echovirus), CMV, and EBV, were all negative. The reverse transcriptase-PCR of the nasopharyngeal swab and total antibody (immunoglobulin [Ig] M + IgG) SARS-CoV-2 rapid test were negative, as was the PCR for other respiratory viruses.

His sister developed a rash with slapped cheek appearance, so we decided to repeat the serologies. Fifteen days after the appearance of skin symptoms, new serologies were performed including specific SARS-CoV-2 IgA + IgM and IgG antibodies. Serologies for parvovirus B19 IgM and IgG antibodies came back positive. Due to the seroconversion of the parvovirus B19 antibodies, the papulovesicular exanthem was attributed to parvovirus B19. The serologies for the rest of the viruses were negative.

Parvovirus B19 can cause different cutaneous manifestations, such as infectious erythema with a slapped cheek appearance, maculopapular rashes, or petechial rashes such as glove and sock syndrome.[4] However, microvesicular exanthems with a varicelliform appearance have been described in parvovirus B19 infections.[3] This exanthem caused by parvovirus B19 suggests a differential diagnosis with the recently described exanthem similar to varicella in COVID-19 patients.[1],[2] Therefore, although the vesicular eruption arising during the COVID-19 pandemic is rare and specific attributed to infection by SARS-CoV-2,[1] we nonetheless encourage the carrying out of serologies for other viruses that habitually produce cutaneous manifestations, such as parvovirus B19 [Table 1].
Table 1: Differential diagnosis of different infectious agents that usually cause vesicular eruptions in childhood

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In conclusion, although this vesicular eruption is emerging during the COVID-19 pandemic, it is necessary to demonstrate its etiology with microbiological diagnostic techniques because other viruses may cause these exanthems.[8]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given the consent for images and other clinical information to be reported in the journal. The guardian understands that name and initial will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients. J Am Acad Dermatol 2020;83:280-5.  Back to cited text no. 1
    
2.
Fernandez-Nieto FD, Ortega-Quijano D, Jimenez-Cauhe J, Burgos-Blasco P, de Perosanz-Lobo D, Suarez-Valle A, et al. Clinical and histological characterization of vesicular COVID-19 rashes: A prospective study in a tertiary care hospital. Clin Exp Dermatol 2020;45:872-5.  Back to cited text no. 2
    
3.
Martín JM, Beteta G, Allende A, Jordá E. Parvovirus B19-associated microvesicular Eruption. Pediatr Dermatol 2015;32:e303-4.  Back to cited text no. 3
    
4.
Ferrari B, Díaz MS, López M, Larralde M. Unusual skin manifestations associated with parvovirus B19 primary infection in children. Pediatr Dermatol 2018;35:e341-4.  Back to cited text no. 4
    
5.
Hou H, Wang T, Zhang B, Luo Y, Mao L, Wang F, et al. Detection of IgM and IgG antibodies in patients with coronavirus disease 2019. Clin Transl Immunology 2020;9:e01136.  Back to cited text no. 5
    
6.
Min SW, Kim YS, Nahm FS, Yoo da H, Choi E, Lee PB, et al. The positive duration of varicella zoster immunoglobulin M antibody test in herpes zoster. Medicine (Baltimore) 2016;95:e4616.  Back to cited text no. 6
    
7.
Heegaard ED, Brown KE. Human parvovirus B19. Clin Microbiol Rev 2002;15:485-505.  Back to cited text no. 7
    
8.
Xu F, Yan Q, Wang H, Niu J, Li L, Zhu F, et al. Performance of detecting IgM antibodies against enterovirus 71 for early diagnosis. PLoS One 2010;5:e11388.  Back to cited text no. 8
    

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Correspondence Address:
Miguel Fernando Garcia-Gil,
Department of Dermatology, Lozano Blesa University Clinical Hospital of Zaragoza, Av. San Juan Bosco 15, 50009, Zaragoza
Spain
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ds.ds_61_20



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