Parvovirus B19 infection presenting as ‘bathing trunk’ erythema with pustules

Abstract

A 7-year-old girl presented with acute vulval erythema and pustules, associated with a petechial eruption in her flexures and over her feet. There was a mild prodromal illness and the patient was afebrile. There were minimal symptoms associated with the rash. Skin and throat swabs were negative and blood examination showed mild neutrophilia and lymphopaenia. Parvovirus B19 IgM was detected on serology and cutaneous features resolved within 4 days. This is a further case of parvovirus B19 infection presenting as a 'bathing trunk' exanthem that has unique dermatologic features, including the presence of pustules and distant petechiae.

Parvovirus B19-associated purpuric–petechial eruption

“…These polymorphous purpuric-petechial eruptions caused by PVB19 are acute selflimiting illness often accompanied by fever and other systemic symptoms such as fatigue, myalgia, anorexia, lymphadenopathy and arthralgia. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][18][19][20][21][22][23] In contrast to EI seen in the post-viremic phase, 24 purpuric-petechial eruptions are closely linked to the viremic phase of primary PVB19 infection. [2][3][4][5][6]8,[11][12][13][14][15][16][18][19][20][21][22] Therefore, patients with papular-purpuric eruptions caused by PVB19 are considered infectious when presenting with the rash.…”

Characterizing Viral Exanthems

“…Other distinctive localized forms of parvovirus-related petechiae and purpura have been described, and given names such as 'bathing suit' and 'acropetechial' syndrome [60,62,63]. Parvovirus B19 has been described recently to cause generalized petechiae [64][65][66].…”

Viral diseases

“…707 It can produce an influenza-like illness, miscarriages, fetal hydrops, neonatal angioedema, 708 polyarthritis, aplastic crises, pure red cell aplasia, 709 purpura, a generalized petechial eruption, 710 a petechial rash of the lower extremities, 711 a 'bathing trunk' exanthem, [712][713][714] vasculitis, 715 erythema multiforme, 716 follicular purpuric papules with a baboon-syndrome-like distribution, 717 dermatomyositis, 718 a Sweet's syndrome-like eruption, 718 lupus erythematosus-like syndromes, 716,718 an asymptomatic papular eruption, livedo reticularis, 719 cutaneous necrosis, 720 acral pruritus, 721 the papular-purpuric (petechial) 'gloves-and-socks' syndrome, 722 and erythema infectiosum (fifth disease). Approximately 80% of the community is immune to the virus by the age of 50 years.…”