Cognitive Deficits, Cerebrospinal Fluid Pleocytosis and White Matter Lesions Following Parvovirus B19 Infection in an Immunocompetent Adult

Thursday, May 29, 2014
Trinity Exhibit Hall
Ariel O Antezana, MD , Neurology, NYU School of Medicine, New York, NY
Joseph Herbert, MD , Neurology, NYU School of Medicine, New York, NY
Ilya Kister, MD , Neurology, NYU School of Medicine, New York, NY

Background:  Parvovirus B19 (PVB19) is a ubiquitous airborne virus that causes erythema infectiosum ('Fifth disease'). Neurologic complications after PVB19 exposure are thought to be transitory and infrequent in the adult population. Cognitive deficits and white matter changes have not been described in immunocompetent adults.

Objectives:  To present a case of a young woman who developed cognitive deficits and subcortical white matter lesions subsequent to Parvovirus B19 (PVB19) infection and to review the literature on neurologic complications of Parvovirus B19 infection.

Methods: Case Report 

Results:  A previously healthy 33-year old woman developed flu-like symptoms 4 days after her daughter was diagnosed with erythema infectiosum. Few days later she noticed memory problems, lack of concentration, word finding difficulties, dizziness and generalized joint and body pains. PVB19 IgG and IgM titers were elevated in serum and viral DNA by PCR in serum showed 9800 copies. Cerebrospinal Fluid (CSF) studies revealed mild lymphocytic pleocytosis (12 white blood cell/cc). Magnetic Resonance Image (MRI) of the brain demonstrated numerous small subcortical and juxtacortical white matter lesions, but no periventricular abnormalities. Extensive infectious, inflammatory and neoplastic causes of encephalopathy were unrevealing. Intravenous Immunoglobulin (IVIG) was administered for 6 months due to persistent viremia. At two year follow-up, patient's symptoms improved significantly, though she continues to have cognitive deficits on neuro-psychological testing as well as vestibular and sensory symptoms. Viral PVB19 DNA in serum and CSF were undetectable at the last follow up.

Conclusions: Persistent cognitive deficits and subcortical white matter lesions can be seen following PVB19 infection in an immunocompetent adult. Patients with neurologic symptoms following PVB19 infection should have serologic and spinal fluid examination assessments for PVB19 as well as MRI of the brain. IVIG should be considered for symptomatic patients with persistent PVB19 viremia.