International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
A case report of papular-purpuric gloves and socks syndrome: A manifestation of the parvovirus B19
Inês Burmester1, André Santa-Cruz1,2, Julieta Ramalho1, Maria João Regadas1, Paulo Gouveia1, Guilherme Castro Gomes1, Cristina Ângela1, Narciso Oliveira1, Fernando Mota-Garcia3, António Oliveira e Silva1
1MD, Department of Internal Medicine, Braga Hospital, Sete Fontes- São Victor, 4710-243 Braga, Portugal.
2MD, Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
3MD, Department of Clinical Pathology, Braga Hospital, Sete Fontes- São Victor, 4710-243 Braga, Portugal.

Article ID: Z01201603CR10609IB
doi:10.5348/ijcri-201622-CR-10609

Address correspondence to:
Inês Seixas de Sá Burmester
Department of Internal Medicine
Braga Hospital, Sete Fontes- São Victor
4710-243 Braga
Portugal

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How to cite this article
Burmester I, Santa-Cruz A, Ramalho J, Regadas MJ, Gouveia P, Gomes GC, Ângela C, Oliveira N, Mota-Garcia F, eSilva AO. A case report of papular-purpuric gloves and socks syndrome: A manifestation of the parvovirus B19. Int J Case Rep Images 2016;7(3):143–148.


Abstract
Introduction: The majority of parvovirus B19 infections are asymptomatic. In childhood, however, they may present as the fifth disease and in adults their manifestations can vary from mild, non-specific, cold-like symptoms to other forms of presentations. Papular-purpuric gloves and socks syndrome (PPGSS) is an uncommon form of parvovirus B19 infection, characterized by symmetric, pruriginous and painful erythema and edema of feet and hands. Generally, systemic symptoms are usually mild and dissemination to other body regions occurs in only 50% of the cases. The rash gradually progresses to petechiae and purpura delineating well demarcated "socks" and "gloves" on both feet and hands. The diagnosis is predominantly based on the clinical features. Serologic conversion is not considered as evidence of parvovirus B19 infection and histopathological findings from lesional skin are not specific. There are no definite antiviral drugs or vaccines against parvovirus. Patients with PPGSS require only symptomatic therapy.
Case Report: We report the case of a 30-year-old female with this characteristic erythema caused by the parvovirus B19. Nevertheless, this case is remarkable because the patient had significant systemic manifestations and an exuberant perineal and oropharyngeal involvement. Further, the erythema assumed a bullous expression that has not been so commonly reported. A biopsy was performed which was unspecific and the diagnosis was confirmed with the serology and molecular detection of the virus in blood sample as well as on mouth swab. Our patient needed treatment to control pain and pruritus, fever was self-limited.
Conclusion: A high index of suspicion is essential to diagnose patients with this syndrome. Early recognition can prevent unproductive measures and the good management of this infection.

Keywords: Human parvovirus B19, Parvovirus B19 infection, Papular-purpuric socks and gloves syndrome, Viral infection


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Author Contributions
Inês Burmester – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
André Santa-Cruz – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Julieta Ramalho – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Maria João Regadas – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Paulo Gouveia – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guilherme Castro Gomes – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Cristina Ângela – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Narciso Oliveira – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Fernando Mota-Garcia – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
António Oliveira e Silva – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Inês Burmester et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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