Brachial plexus neuropathy associated with human parvovirus infection

Abstract

SHORT REPORTS Brachial plexus neuropathy associated with human parvovirus infectionHuman parvovirus is a recognised cause of arthritis.' A recent report suggests that it may also cause brachial plexus neuropathy.2 We describe a patient who presented with both articular and neurological manifestations of infection.Case report A previously fit 23 year old nurse presented in January 1986 with pain in both arms. Two weeks earlier she had noticed an erythematous rash which spread from the legs to the abdomen and arms but spared the upper trunk and face. Within hours she developed pain in the ankles and knees, and by 48 hours she had pain in the neck and shoulders, weakness of the arms, and numbness and dysaesthesia of the right forearm. There was no history of recent immunisations. She had in the past been immunised against poliomyelitis.On examination she was found to be alert with no fever or meningeal irritation. The rash was no longer apparent and the joints were normal. There was pronounced tenderness of both trapezius muscles, deltoids, and biceps and severe weakness of shoulder abduction. Both biceps reflexes and the left supinator reflex were reduced. An area of sensory loss was detected over the radial border of the right forearm.Full blood count, erythrocyte sedimentation rate, biochemical profile, blood glucose concentration, and serum creatine kinase activity were normal. An autoimmune profile was negative and no circulating immune complexes were detected. Cerebrospinal fluid contained normal amounts of cells and protein.Electromyography showed severe denervation in deltoid, supraspinatus, and infraspinatus muscles bilaterally. The The pain resolved within four weeks but severe wasting of both deltoids and the left supjaspinatus and infraspinatus and right biceps muscles occurred and the biceps and supinator reflexes were completely lost. Six months later wasting and weakness had improved and sensory loss had recovered. CommentAcute neuropathy of the brachial plexus (neuralgic amyotrophy) is characterised by the sudden onset of pain around the shoulder girdle followed by weakness and wasting of periscapular and arm muscles. Sensory impairment is common. Complete recovery taking up to three years is the rule.3 An association with various inoculations, infections, and surgical procedures has been described.3Viraemia due to human parvovirus was first described in 1975, and the virus has subsequently been incriminated as a cause of aplastic crises in people with various chronic haemolytic anaemias, of erythema infectiosum, and of arthralgia or arthritis.45 There have been no reports of neurological illness other than brachial plexus neuropathy due to parvovirus in man.Our patient showed serological evidence of recent parvovirus infection coincident with the development of brachial plexus neuropathy. There was also evidence of adenovirus infection occurring between the two tests; adenovirus, however, have rarely been implicated as a cause ofarthralgia and never as a cause of brachial plexus neuropathy, nor did...

Neurological manifestations of human parvovirus B19 infection

“…Six case reports of neuralgic amytrophy associated with the acute phase of B19 infection have been reported [112][113][114][115][116][117]. These cases occurred in middleaged persons who developed the neurological symptoms either at the same time [112,117] or slightly after [113][114][115][116] the appearance of the typical rash of EI. All of them achieved complete recovery, although the recovery was generally delayed.…”

Neurologic Manifestations Associated with Parvovirus B19 Infection

“…Deep tendon reflexes in the affected areas were decreased or absent in all patients. Bilateral involvement was reported in 3 (43%) of 7 cases [37,41,61]. Electromyography revealed denervation [36,37,39,61] and decreased nerve conduction velocities [38].…”

Pathogenesis of human parvovirus B19 in rheumatic disease

“…173-176 Peripheral nerve abnormalities associated with B19 infection include brachial plexus neuropathy,53 54 carpal tunnel syndrome,181paraesthesias,182 myasthenia-like weakness,153 and paralysis of the ulnar nerve 183…”