AB1050 Reactive arthritis due to parvovirus b19 may be overlooked in adult rheumatology
Authors: K. Hutton, K.M. Carlsen
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In 1991 parvovirus B19 analyses, for the 5th disease of childhood, were established in Denmark, revealing the first epidemic. Prior to this, erythema infectiosum, "slapped cheek appearance" and reactive arthritis were only clinical diagnoses. A project in the PhD thesis Human Parvovirus B19 Erythrovirus – Methods established for <sup>Virological and Diagnostic Aspects 2006</sup> APMIS 120;114:1–121, revealed that 35.4% of 3.628 pregnant women were susceptible to parvovirus B19 infection. <h3>Objectives</h3> To present manifestations of parvovirus B19 in a susceptible adult population <h3>Methods</h3> ,<sup>During the years 2011</sup><sup>2014 and 2017</sup> the following patients were admitted. Case 1: A 61-year-old woman with rash and thrombocytopenic purpura in April 2011. Routine blood tests, RF, anti-CCP, tuberculosis, ANA and anti-ds DNA, serological tests for viral and autoimmune hepatitis were performed. Also ECG and finally, parvovirus B19 IgM and IgG, PCR for Parvovirus B19 was performed, June 2011 Case 2: A 52-year-old woman with rash, swollen joints and pericarditis in May 2011 Case 3: A 45-year-old woman with swollen joints, March 2011 Case 4: A 45-year-old woman with swollen joints and rash, November 2014 Case 5: A 68-year-old man admitted to the Department of Dermatology and diagnosed with Sweet's Syndrome, severe anaemia and swollen joints, September 2014 Case 6: A 62-year-old woman transferred due to parvovirus B19 positive IgM and IgG antibodies with reactive arthritis and itching skin rash, June 2017 All six patients were tested as mentioned above in Case 1. <h3>Results</h3> In all 6 patients, routine tests were normal. HBV, STD, ANA, anti-dsDNA, TB, RF and anti-CCP were negative. Parvovirus DNA by PCR, IgM and IgG antibodies were positive except for the last patient, who did not have PCR but a punch biopsy of her maculo-papulary rash performed. Ultrasound revealed oedema and synovitis in the patients. The 1st patient contracted parvovirus B19 from her 4-year-old grandchild, the 2nd during work in a daycare. They both had self-limiting infections and pericarditis resolved without treatment. The 3rd patient was also infected from daycare and her persistent synovitis, required DMARDs and biologic treatment. The 4th patient was treated with DMARDs for one year. The 5th patient had severe anaemia for ½ year, almost overlooked due to Sweet's syndrome but his anaemia (due to replication of the parvovirus in erythroblasts) was finally diagnosed. The patient continues treatment for Sweet's Syndrome at the Department of Dermatology. The 6th patient slowly recovered from her skin rash and reactive arthritis. <h3>Conclusions</h3> The 5th disease of childhood was almost overlooked in 6 patients probably due to their ages. Therefore, clinicians must be aware of the need for parvovirus B19 analyses in seronegative RA patients. Parvovirus B19 occurs as epidemics approximately every 3rd year as an occupational risk, jeopardising patients' female family members who may be pregnant and develop foetal hydrops and anaemia necessitating intrauterine blood transfusion at a Foetal Medical Centre. <h3>Disclosure of Interest</h3> None declared