Pediatric systemic lupus erythematosus and human parvovirus B19 infection

Abstract

Aim: To describe presentation and course of paediatric systemic lupus erythematosus (pSLE), associated with Parvovirus B19(PB19) primoinfection. Methods: Retrospective monocentric study of patients with pSLE, defined according to ARA criteria, diagnosed before 16 years old, and associated with PB19 primo-infection, defined by the presence of PB19 IgM antibodies and PB19 DNA detected by PCR in blood and/or in tissue. Results: 3 girls aged from 8 years to 15 years 8 months have been included. PB19 infection was present at diagnosis in all patients. Maternal history of autoimmune diseases was noted in a consanguineous family. Clinical manifestations at diagnosis were fever(3), arthritis/arthralgia (3), skin rash (1), grade IV glomerulonephritis (1), interstitial pneumonia (1), cerebral vasculitis (1), pericarditis/pleurisy (1), adenopathy (2), hepatomegaly/splenomegaly (1). Aregenerative anaemia requiring packed red blood cell transfusion was present in all patients. AAN (3), anti -DNA (3), anti-SSa (1), anti-SSb (1), antiphospholipid (1), anti-platelet (2), rheumatoid factor (2), pANCA (1), antiactin (1) antibodies were found. PB19 PCR was positive in blood (3), bone marrow (2) and kidney (1). Corticosteroids have been initiated for the 3 patients, in association with one or more immunosuppressive therapies. A sustained remission has been observed in 2 patients after a follow-up of 4 years and 1 year 8 months off-therapy respectively. A severe course with joint damages, recurrent pericarditis and gradeIV glomerulonephritis, associated with persistent infection by PB19, has been observed in the third case (family autoimmunity history). Conclusion: PB19 infection-associated-pSLE may evolve either to a persistent remission off-therapy or to a severe pSLE. It should be considered in patient with pSLE associated with a severe aregenerative anemia.