Parvovirus B19-associated catastrophic endothelialitis with a Degos-like presentation.

[malignant atrophic papulosis]

Parvovirus B 19 is a single -stranded DNA virus exhibiting affinity for a variety of cell types including endothelial cells . The basis of the affinity is globoside expression , the receptor for B 19 . B 19 endothelial cell parasitism accelerates endothelial cell apoptosis , potentially critical in inducing neoantigenicity and secondary antibody formation . A 38 -year -old previously healthy male developed intestinal and cutaneous infarction , elevated creatinine phosphokinase (CPK ) levels and progressive cytopenias . The basis of his clinical presentation was unclear until a skin biopsy suggested a potential role for virally mediated endothelial cell injury . Hematoxylin and eosin , immunohistochemical , immunofluorescent and reverse transcriptase in situ polymerase chain reaction studies were conducted on skin biopsies to assess for viral triggers . B 19 viremia and localization of B 19 RNA transcripts to vascular endothelium were uncovered . A diagnosis of catastrophic endothelial cell injury attributable to B 19 infection was rendered . The patient showed significant improvement with intravenous immunoglobulin (IVIG ). Parvovirus B 19 is a ubiquitous virus that in the majority of affected patients remains asymptomatic . Nevertheless , because of its ability to infect endothelium it can cause severe multiorgan endothelial cell injury .