Cryoglobulinaemic Vasculitis Secondary to Parvovirus B19 Infection: A Case-Based Review.

Parvovirus B19 (B19V) is a common viral agent that may cause arthritis in adults. In rare cases, B19V has been associated with cryoglobulinaemic vasculitis. We report the case of a 47-year-old woman who presented with an acute febrile polyarthritis and palpable purpura on the lower limbs. Laboratory investigations revealed low complement C4, positive IgM and IgG for Parvovirus B19, and detectable serum cryoglobulins, which immunofixation was consistent with type III cryoglobulinemia. The patient responded favourably to corticosteroid therapy, with complete resolution of symptoms. One month after premature discontinuation of steroids, she experienced a relapse of polyarthralgia. A second course of low-dose corticosteroids led to sustained remission, without further relapse. In order to understand the clinical features of B19V-associated cryoglobulinaemic vasculitis, we conducted a narrative review of the literature using the PubMed database, in which we identified seven cases. The most frequent features included constitutional symptoms, cutaneous vasculitis, joint involvement and complement consumption. One previous case clearly identified type III cryoglobulinemia. These findings highlight the clinical heterogeneity of this entity and the importance of considering B19V in the differential diagnosis of small-vessel vasculitis with cryoglobulinemia, particularly in seronegative patients for hepatitis C and autoimmune diseases.