Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 13, Number 5, May 2022, pages 229-234

A One-Year-Old Girl With Human Parvovirus B19 Infection and Hypocomplementemia Mimicking Incomplete Kawasaki Disease

Figures

Figure 1.
Figure 1. A 1-year-old Japanese girl with fever and skin rash. At admission, 4 days after symptom onset, photographs of patient’s skin demonstrated rash on her face (a), left knee (b), and back (c). A fine papular erythema is visible.
Figure 2.
Figure 2. A 1-year-old Japanese girl with fever and skin rash. At discharge, 14 days after symptom onset, photographs of patient’s skin demonstrated rash on her foot (a) and trunk (b). The rash changed into a lacy, reticulated appearance similar to that of erythema infectiosum.
Figure 3.
Figure 3. A 1-year-old Japanese girl with fever and skin rash for 4 days: clinical course in relation to symptoms and laboratory findings. The horizontal axis shows the course over time in days after the onset of the patient’s symptoms. AMPC: amoxicillin; CRP: C-reactive protein; CH50: total hemolytic complement; IgM: immunoglobulin M; IgG: immunoglobulin G; B19: human parvovirus B19; EIA: enzyme immunoassay.

Tables

Table 1. Laboratory Findings at Admission and 4 Days After Symptom Onset of a 1-Year-Old Japanese Girl With Fever and Skin Rash for 4 Days
 
Laboratory testValue (normal range)
WBC: white blood cell; RBC: red blood cells; PT-INR: prothrombin time-international normalized ratio; aPTT: activated partial thromboplastin time; ESR: erythrocyte sedimentation rate; AST: aspartate transaminase; ALT: alanine transaminase; LDH: lactate dehydrogenase; CK: creatine kinase; T-Bil: total bilirubin; TP: total protein; BUN: blood urea nitrogen; NT-proBNP: N-terminal fragment of pro-B-type natriuretic peptide; CRP: C-reactive protein; Ig: immunoglobulin; sIL-2R: soluble interleukin-2 receptor; CH50: total hemolytic complement.
WBC count5,760/µL
Neutrophils66%
Lymphocytes29%
Monocytes2%
Eosinophils0%
Basophils1%
Atypical2%
RBC523 × 104/µL
Hemoglobin15.2 g/dL
Hematocrit45.7%
Platelets20.3 × 104/µL
PT-INR1.06
aPTT45.3 s
Fibrinogen243 mg/dL
D-dimer2.8 µg/mL
ESR8 mm/h
AST58 IU/L
ALT19 IU/L
LDH588 IU/L
CK54 IU/L
T-Bil0.3 mg/dL
TP6.9 g/dL
Albumin4.1 g/dL
BUN14.4 mg/dL
Creatinine0.27 mg/dL
Natrium133 mEq/L
Potassium4.2 mEq/L
Chloride97 mEq/L
Calcium9.2 mg/dL
Inorganic phosphorus4.7 mg/dL
NT-proBNP310.9 pg/mL (< 50)
CRP0.14 mg/dL
IgG827.0 mg/dL
IgA115.4 mg/dL
IgM317.2 mg/dL
β2-microglobulin4.8 mg/L (0.0 - 2.0)
Ferritin147 ng/mL (12 - 60)
sIL-2R5,877 U/mL (122 - 496)
CH5017.2 U/mL (25 - 48)
C361.9 mg/dL (73 - 138)
C411.9 mg/dL (11 - 31)
Urinalysis
 Red blood cellsNegative
 White blood cellsNegative
 ProteinNegative

 

Table 2. Laboratory Findings at Admission of a 1-Year-Old Japanese Girl With Fever and Skin Rash for 4 Days
 
ParametersaValues at admission (normal range)
aParameters related to infectious and autoimmune diseases. Anti-dsDNA antibodies: anti-double-stranded DNA antibodies; M. pneumoniae: Mycoplasma pneumoniae; Ig: immunoglobulin; EBV: Epstein-Barr virus; VCA: virus capsid antigen; EBNA: EBV nuclear antigen; CMV: cytomegalovirus; B19: human parvovirus B19; EIA: enzyme immunoassay.
Anti-nuclear antibodies40 (1:n)
Rheumatoid factor< 15 IU/mL
Anti-dsDNA antibodies< 10 IU/mL
Streptococcus pyogenes antigenNegative
Adenovirus antigenNegative
M. pneumoniae IgMNegative
M. pneumoniae IgG32 (1:n)
M. pneumoniae PCRNegative
EBV VCA-IgG (EIA)0.6 (< 0.5)
EBV VCA-IgM (EIA)0.0 (< 0.5)
EBNA (EIA)0.2 (< 0.5)
CMV IgG (EIA)10.3 (< 2.0)
CMV IgM (EIA)0.39 (< 0.8)
B19 IgM (EIA)1.38 (< 0.8)