Fever with rash over palms and soles along with hepatomegaly – Can it be parvovirus infection?

Amit Dashputra¹, Ira Shah^2
1Seth G S Medical College, Mumbai, India, ²Pediatric Infectious Diseases, Levioza Health Care, Mumbai, India

Address for Correspondence: Amit Dashputra, Seth G S Medical College, Mumbai, India. Email: amitdashputra@outlook.com

Clinical Problem:
A 4-year-old female presented with fever for 5 days. She had red eyes along with fever for the initial 2 days. Subsequently, she developed rash over palms and soles after 2 days of fever, which had resolved without scarring at the time of presentation to us. She had been investigated by the referring doctor and was detected to have pancytopenia (white blood cell count of 3000/mm3, hemoglobin 8.7gm/dL, platelets 1,16,000/mm3) with a bilirubin 2.01mg/dl. Dengue IgM, HIV Elisa was negative and chest radiograph was normal. She was treated with IV ceftriaxone for the past 3 days in view of clinical suspicion of enteric fever but there was no response and was thus referred to us for further management. On presentation, on systemic examination, she had hepatomegaly. Other systems and vital parameters were normal. We advised for a blood culture, Weil Felix test, Brucella IgM, Leptospirosis IgM, Parvovirus B19 IgM and to continue IV ceftriaxone with monitoring of the hemogram. On next follow up after 6 days, the fever had subsided. Brucella IgM, Leptospira IgM, Weil Felix test was negative. Parvovirus IgM was positive (18.9mcg/ml). Blood culture did not grow any organism. Hemogram showed an improvement (white blood cell count of 9400/mm3, hemoglobin 8.8gm/dL, platelets 2,12,000/mm3). In view of recovery of hemogram and resolution of fever, the child was not treated for the parvovirus infection.

When to suspect parvovirus infection in a child with fever?