Systemic Lupus Erythematosus and Parvovirus B-19: Casual Coincidence or Causative Culprit?

Abstract

Systemic lupus erythmatosus (SLE) is a multi-system autoimmune disease characterized by auto-reactive cells and auto-antibodies, which can potentially affect all organ systems. Typical organ systems that are affected include the heart, lungs, skin, kidneys, and central nervous system. Its expression is believed to be dependent on various factors such as genetic predisposition, environmental agents, immune dysregulation, crossreactivity with auto-antigens, alterations in auto-antigens, or most likely, a combination of these. Parvovirus B19, a virus which commonly runs an asymptomatic or benign self-limiting course such as erythema infectiosum, transient aplastic crisis, flu-like symptoms, rash, arthalgia, and arthritis, has recently been associated with a number of rheumatic diseases, more specifically with SLE. Like SLE, it can present with multi- systemic symptoms resembling SLE both clinically and serologically. Similarities have been so striking that patients have been initially misdiagnosed with SLE, having fulfilled 3-5 of the criteria of the American College of Rheumatology, currently used for the diagnosis of SLE, only to discover later that they were infected by parvovirus B19. This paper will discuss parvovirus' link to SLE, its similarities and differences, and whether parvovirus can act as a trigger of, or simply mimic, SLE.

Parvovirus B19 and immune disorders

“…9 In the case of systemic lupus erythematosus (SLE) the correlation between PVB19 infection was considered by different authors as more or less probable. [10][11][12][13] Analogously the role of PVB19 infection on other connective diseases such as Sjögren syndrome (SS), 14 and systemic dermatosclerosis, 2,15 or cryoglobulinemia 16 is still discussed. In contrast, Seve et al 3 think that only in rare cases can PVB19 act as a trigger of RA, SLE or vasculitis.…”

Parvovirus infection mimicking systemic lupus erythematosus

“…Clinical clues can help to differentiate the 2 entities (Box 1). 19 To avoid an incorrect or premature diagnosis of lupus, health care providers should be aware of the association between autoantibodies and parvovirus infection. This is especially relevant in patients who present with persistent joint symptoms after their rash has resolved.…”

Infections and Systemic Lupus Erythematosus

“…Parvovirus infection has also been associated with pure red-cell aplasia, hydrops fetalis and acute and chronic arthropathy; other clinical manifestations such as rash, fever, lymphadenopathy, and blood cell abnormalities may also puzzle the clinician into a misdiagnosis of SLE. Careful assessment and follow-up will differentiate between both conditions (Severin et al, 2003). Diagnosis of infection is made by serology or viral DNA amplification, no treatment for this condition has been described as a great majority of cases have self-limited disease.…”