Which physical findings are characteristic of parvovirus B19-caused viral arthritis?

Updated: Nov 12, 2019
  • Author: Rabea Ahmed Khouqeer, MD, FRCPC, FAAAAI; Chief Editor: Herbert S Diamond, MD  more...
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Clinical features of arthritis associated with parvovirus B19 infection in children include the following:

  • As many as 70% of patients are asymptomatic
  • A few may have flulike symptoms (eg, fever, headache, sore throat, cough, anorexia, vomiting, diarrhea, or arthralgia)
  • A bright red rash is typically noted, often characterized as having a “slapped-cheek” appearance (see the images below)
  • Joint symptoms are rare (5-10%)
  • Viral arthritis. Typical "slapped cheek" appearanc Viral arthritis. Typical "slapped cheek" appearance. Courtesy of Brenda Moroz, MD, Montreal Children's Hospital.
    Viral arthritis. "Slapped cheeks" with typical ret Viral arthritis. "Slapped cheeks" with typical reticulated erythema of arms. Courtesy of Brenda Moroz, MD, Montreal Children's Hospital.

Clinical features in adults include the following:

  • Rash is rare

  • Joint symptoms occur in as many as 60% of patients, with arthralgia noted more commonly than frank arthritis; arthralgia is usually self-limited and symmetrical and is noted in peripheral small joints, hands (ie, proximal interphalangeal and metacarpophalangeal joints), wrists, knees, and ankle joints, in association with prominent morning stiffness and swelling

  • Several diseases may arise as a consequence of parvovirus B19 infection, such as erythema infectiosum (fifth disease), transient aplastic crisis (especially in patients with sickle cell disease, thalassemia, or HIV-induced anemia), and fetal hydrops in infected mothers

Rare clinical features include the following:

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