Immunologic Storm Simulating Systemic Lupus Erythematosus Following Parvovirus B19 Infection
  • Roxana González-Mazarío
    Department of Internal Medicine, Hospital Universitari i Politècnic La Fe, Valencia
  • Luisa Suárez Álvarez
    Department of Emergency, Hospital Dr. Peset, Valencia
  • Luisa Micó
    Department of Internal Medicine, Hospital Universitari i Politècnic La Fe, Valencia
  • Inés Moret Tatay
    Instituto de Investigación Sanitaria, Hospital La Fe, Valencia CIBERehd, Barcelona
  • Miguel Salavert Lletí
    Infectious Disease Unit, Hospital Universitari i Politècnic La Fe, Valencia

Keywords

Parvovirus B19 infection, SLE, cytokines

Abstract

Background: The appearance of symptoms compatible with systemic autoimmune diseases has been described in relation to several viral infections like HIV, cytomegalovirus and especially PVB19, depending on the evolution of the immunological condition of the host and their age. We present a young immunocompetent male patient, with clinical manifestations simulating systemic lupus erythematosus (SLE) with important activation of cytokines.

Methods: For quantification of the different cytokines in plasma, a commercially available multiplex bead immunoassay, based on the Luminex platform (Cat # HSCYTO-60SK-08, Milliplex® MAP High Sensitivity, Millipore), was used according to the manufacturer’s instructions. All samples were run in duplicate and the data (mean fluorescence intensity) were analyzed using a Luminex reader. The mean concentration was calculated using a standard curve.

Results: The clinical evolution was favourable without the need for any specific treatment, showing complete recovery after two months. Whilst the symptoms and viral charge were disappearing, the anti-DNA continued to increase and we demonstrate important activation of IL-10, IL-6 and TNF? cytokines as a result of a hyperstimulating response by an immunocompetent hyperfunctional system, which persists after clinical improvement. We should emphasize the behaviour of two cytokines: IL-12p70 and IL-2, which showed opposite tendencies.

Conclusions: Viral infections, especially PVB19, can produce or simulate several autoimmune diseases as a hyperstimulation response from an immunocompetent hyperfunctional system. Consequently, a persistent increase of autoantobodies and important activation of cytokines, even after clinical improvement and seroconversion, can be demonstrated.

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References

  • Cossart YE, Field AM, Cant B, Widdows D. Parvovirus-like particles in human sera, Lancet 1975;1:72.
  • Heegaard ED, Brown KE. Human parvovirus B19, Clin. Microbiol. Rev. 2002;15;485–505.
  • Servant A, Laperche S, Lallemand F, Marinho V, De Saint Maur G, Meritet JF et al. Genetic diversity within human erythroviruses: identification of three genotypes, J. Virol. 2002;76:9124.
  • Young NS, Brown KE. Parvovirus B19, N. Engl. J. Med. 2004;350:586.
  • Broliden K, Tolfvenstam T, Norbeck O. Clinical aspects of parvovirus B19 infection, J. Intern. Med. 2006;260:285–304.
  • Sève P, Ferry T, Charhon A, Calvet A, Broussolle C. Systemic manifestations of parvovirus B19 infections, Rev. Med. Interne 2004;25:740–751.
  • Brown KE. The expanding range of parvoviruses which infect humans, Rev. Med. Virol. 2010;20:231–244.
  • Hayakawa H, Tara M, Niina K, Osame M. A clinical study of adult human parvovirus B19 infection, Intern. Med. 2002;41:295.
  • Woolf AD, Campion GV, Chishick A, Wise S, Cohen BJ, Klouda PT et al. Clinical manifestations of human parvovirus B19 in adults, Arch. Intern. Med. 1989;149:1153.
  • Dijkmans AC, de Jong EP, Dijkmans BA, Lopriore E, Vossen A, Walther FJ, Oepkes D. Parvovirus B19 in pregnancy: prenatal diagnosis and management of fetal complications, Curr. Opin. Obstet. Gynecol. 2012;24:95–101.
  • Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum; 199;40:1725
  • Adamson LA, Fowler LJ, Clare-Salzler MJ, Hobbs JA. Parvovirus B19 infection in Hashimoto's thyroiditis, papillary thyroid carcinoma, and anaplastic thyroid carcinoma, Thyroid 2011;21:411–417.
  • Mogensen TH, Jensen JM, Hamilton-Dutoit S, Larsen CS. Chronic hepatitis caused by persistent parvovirus B19 infection, BMC Infect. Dis. 2010;10:246.
  • Cope AP, Jones A, Brozovic M, Shafi MS, Maini RN. Possible induction of systemic lupus erythematosus by human parvovirus, Ann. Rheum. Dis. 1992;51:803–804.
  • Ramos-Casals M, Cuadrado MJ, Alba P, Sanna G, Brito-Zerón P, Bertolaccini L et al. Acute viral infections in patients with systemic lupus erythematosus: description of 23 cases and review of the literature, Medicine (Baltimore) 2008;87:311–318.
  • Negro A, Regolisti G, Perazzoli F, Coghi P, Tumiati B, Rossi E. Human parvovirus B19 infection mimicking systemic lupus erythematosus in an adult patient, Ann Ital Med Int 2001;16:125–127.
  • Moore TL, Bandlamudi R, Alam SM, Nesher G. Parvovirus infection mimicking systemic lupus erythematosus in a pediatric population, Semin. Arthritis Rheum. 1999;28:314–318.
  • Tanaka A, Sugawara A, Sawai K, Kuwahara T. Human parvovirus B19 infection resembling systemic lupus erythematosus, Intern. Med. 1998;37:708–710.
  • Roblot P, Roblot F, Ramassamy A, Becq-Giraudon B. Lupus syndrome after parvovirus B19 infection, Rev. Rhum. Engl. Ed. 1997;64:849–851.
  • Díaz F, Collazos J, Mendoza F, De la Viuda JM, Cazallas J, Urkijo JC et al. Systemic lupus erythematosus associated with acute parvovirus B19 infection, Clin. Microbiol. Infect. 2002;8:115–117.
  • Severin MC, Levy Y, Shoenfeld Y. Systemic lupus erythematosus and parvovirus B-19: casual coincidence or causative culprit? Clin. Rev. Allergy Immunol. 2003;25:41–48.
  • Suzuki T, Saito S, Hirabayashi Y, Harigae H, Ishii T, Kodera T et al. Human parvovirus B19 infection during the inactive stage of systemic lupus erythematosus, Intern. Med. 2003;42:538–540.
  • Sève P, Ferry T, Koenig M, Cathebras P, Rousset H, Broussolle C. Lupus-like presentation of parvovirus B19 infection, Semin. Arthritis Rheum. 2005;34:642–648.
  • Bengtsson A, Widell A, Elmstâhl S, Sturfelt G. No serological indications that systemic lupus erythematosus is linked with exposure to human parvovirus B19, Ann. Rheum. Dis. 2000;59:64–66.
  • Aslanidis S, Pyrpasopoulou A, Kontotasios K, Doumas S, Zamboulis C. Parvovirus B19 infection and systemic lupus erythematosus: activation of an aberrant pathway? Eur. J. Intern. Med. 2008;19:314–318.
  • Nesher G, Osborn TG, Moore TL. Parvovirus infection mimicking systemic lupus erythematosus, Semin. Arthritis Rheum. 1995;24:297–303.
  • Rigante D, Mazzoni MB, Esposito S. The cryptic interplay between systemic lupus erythematosus and infections, Autoimmun. Rev. 2014;13:96–102.
  • Hession MT, Au SC, Gottlieb AB. Parvovirus B19-associated systemic lupus erythematosus: clinical mimicry or autoimmune induction? J. Rheumatol. 2010;37:2430–2432.
  • Norbeck O, Isa A, Pöhlmann C, Broliden K, Kasprowicz V, Bowness P et al. Sustained CD8+ T-cell responses induced after acute parvovirus B19 infection in humans, J. Virol. 2005;79:12117.
  • Wagner AD, Goronzy JJ, Matteson EL, Weyand CM. Systemic monocyte and T-cell activation in a patient with human parvovirus B19 infection, Mayo Clin. Proc. 1995;70:261.
  • Park SJ, Kim JH, Ha TS, Shin JI. Association of parvovirus B19 infection with systemic lupus erythematosus: role of Th1 predominance, J. Rheumatol. 2011;38:1221.
  • Kerr JR, Barah F, Mattey DL, Laing I, Hopkins SJ, Hutchinson IV et al. Circulating tumour necrosis factor-alpha and interferon-gamma are detectable during acute and convalescent parvovirus B19 infection and are associated with prolonged and chronic fatigue, J. Gen. Virol. 2001;82:3011–3019.
  • Lauweyrs BR, Garot N, Renauld JC, Houssiau FA. Interleukin-10 blockade corrects impaired in vitro cellular immune response of systemic lupus erythematosus patients, Arthritis Rheum. 2000;43:1976–1981.
  • Lauweyrs BR, Houssiau FA. Involvement of cytokines in the pathogenesis of systemic lupus erythematosus, in Cytokines and Chemokines in Autoimmune Disease. P. Santamaria and P. Hackett, Eurekah.com and Kluwer Academic/Plenum, 2003.
  • Toan NL, Sy BT, Song le H, Luong HV, Binh NT, Binh VQ et al. Co-infection of human parvovirus B19 with Plasmodium falciparum contributes to malaria disease severity in Gabonese patients, BMC Infect. Dis. 2013;13:375.
  • Scroggie DA, Carpenter MT, Cooper RI, Higgs JB. Parvovirus arthropathy outbreak in south-western United States, J. Rheumatol. 2000;27:2444.
  • Naides SJ. Rheumatic manifestations of parvovirus B19 infection, Rheum. Dis. Clin. North Am. 1998;24:375–401.
  • Pavlovic M, Kats A, Cavallo M, Shoenfeld Y. Clinical and molecular evidence for association of SLE with parvovirus B19, Lupus 2010;19:783–792.
  • Pugliese A, Beltramo T, Torre D, Roccatello D. Parvovirus B19 and immune disorders, Cell Biochem. Funct. 2007;25:639–641.
  • Meyer O. Parvovirus B19 and autoimmune diseases, Joint Bone Spine 2003;70:6–11.
  • Kozireva SV, Zestkova JV, Mikazane HJ, Kadisa AL, Kakurina NA, Lejnieks AA et al. Incidence and clinical significance of parvovirus B19 infection in patients with rheumatoid arthritis, J. Rheumatol. 2008;35:1265–1270.
  • Chen DY, Chen YM, Lan JL, Tzang BS, Lin CC, Hsu TC. Significant association of past parvovirus B19 infection with cytopenia in both adult-onset Still's disease and systemic lupus erythematosus patients, Clin. Chim. Acta 2012;413:855–860.
  • Shauer A, Gotsman I, Keren A, Zwas DR, Hellman Y, Durst R et al. Acute viral myocarditis: current concepts in diagnosis and treatment, Isr Med Assoc J 2013;15:180–185.
  • Terhes G, Jenei M, Bereg E, Túri S, Deák J. Neurologic consequence of a parvovirus B19 infection, J. Clin. Virol. 2013;56:156–158.
  • Wildig J, Michon P, Siba P, Mellombo M, Ura A, Mueller I et al. Parvovirus B19 infection contributes to severe anemia in young children in Papua New Guinea, J. Infect. Dis. 2006;194:146.
  • Segovia JC, Guenechea G, Gallego JM, Almendral JM, Bueren JA. Parvovirus infection suppresses long-term repopulating hematopoietic stem cells, J. Virol. 2003;77:8495–8503.
  • Lieberman LA, Tsokos GC. The IL-2 defect is systemic lupus erythematosus disease has an expansive effect on host immunity, J Biomed. Biotechnol. 2010;2010:ID740619.

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    Published: 2015-02-06
    Issue: Vol. 2 No. 1 (2015) (view)

    How to cite:
    1.
    González-Mazarío R, Suárez Álvarez L, Micó L, Moret Tatay I, Salavert Lletí M. Immunologic Storm Simulating Systemic Lupus Erythematosus Following Parvovirus B19 Infection. EJCRIM 2015;2 doi:10.12890/2015_000154.