Reactivation of Parvovirus B19 Infection: An Uncommon Trigger of Macrophage Activation Syndrome in Adult-Onset Still's Disease

Natnicha Leelaviwat; Sabiha Armin; Poemlarp Mekraksakit; Kenneth Nugent

doi:10.7759/cureus.37231

Reactivation of Parvovirus B19 Infection: An Uncommon Trigger of Macrophage Activation Syndrome in Adult-Onset Still's Disease

Cureus. 2023 Apr 6;15(4):e37231. doi: 10.7759/cureus.37231. eCollection 2023 Apr.

Authors

Natnicha Leelaviwat¹, Sabiha Armin², Poemlarp Mekraksakit³, Kenneth Nugent⁴

Affiliations

¹ Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA.
² Internal Medicine, University of Texas Health Science Center at Houston, Houston, USA.
³ Nephrology and Hypertension, Mayo Clinic, Rochester, USA.
⁴ Internal Medicine/Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, Lubbock, USA.

Abstract

A 40-year-old woman presented with four weeks of intermittent high-grade fever, cough, and joint pain, and two weeks of a generalized rash. She was found to have adult-onset Still's disease (AOSD) and rapidly developed macrophage activation syndrome (MAS) on the second day of admission. Among infectious etiologies, Epstein-Barr virus and members of the herpes virus family are common triggers of MAS. However, our patient was found to have reactivation/recurrence of parvovirus B19 infection as the cause; this is an uncommon trigger reported infrequently in the medical literature. Despite intensive treatment, the patient passed away.

Keywords: adult-onset still’s disease; fever of unknown origin; hemophagocytic lymphocytic histiocytosis; macrophage activation syndrome; parvovirus b19.

Publication types

Case Reports