Skin - nontumor
Infectious disorders
Parvovirus B19

Author: Abha Soni, D.O., M.P.H. and Mowafak Hamodat MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 17 May 2016, last major update May 2016

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Parvovirus B19 [title]

Cite this page: Parvovirus B19. website. Accessed October 27th, 2016.
Definition / General
  • Viral infection that typically causes mild rash in children
  • Clinical syndrome is called "Fifth disease" or erythema infectiosum
  • Parvovirus B19 is spread by respiratory droplets, and has an incubation period of 5 - 14 days
  • Viral receptor is the erythrocyte P antigen, which is expressed on endothelial cells
  • Parvovirus attacks erythroblasts; may cause acute anemic crisis in patients with accelerated erythropoiesis, immunocompromised or minimal reserve (chronic anemia, hemolytic anemia, sickle cell, fetuses), although usually recipients have no symptoms (Transfusion 2005;45:1811)
  • Pregnant women may pass virus to fetus, where it may cause marked fetal anemia and hydrops
  • Rash may be due to delayed type hypersensitivity, antibody dependent cellular immunity against microbial antigens in epidermis or endothelium, or circulating immune complexes
Clinical Features
  • Causes “Fifth disease" in children, a mild illness with a “slapped cheek” facial rash
  • Characteristic skin manifestations are petechial eruption in a glove and stocking distribution, reticular truncal erythema, and "slapped cheek" sign (Hum Pathol 2000;31:488)
  • May produce influenza - like illness, miscarriage, fetal hydrops and neonatal angioedema
  • Atypical presentations include generalized petechial rash (Pediatrics 2010;125:e787), asymptomatic papular eruption or lower extremity palpable purpura, red baby syndrome (Indian J Pediatr 2009;76:309), papular purpuric gloves and socks syndrome (Med Oral Patol Oral Cir Bucal 2007;12:E4); may resemble Sweet’s syndrome, myopathic dermatomyosis or lupus erythematosus (Intern Med 1998;37:708)
  • Immune responses usually clear infection and provide lifelong protection, but virus may persist in blood or tissue (Transfus Med 2007;17:263)
  • Parvovirus B19 has been associated with some cases of Rosai - Dorfman disease (J Clin Pathol 2006;59:1320)
Case Reports
  • Usually self resolving
  • Can treat symptoms of fever, joint pain, swelling and itching
  • Children and healthy adults have complete recovery
Clinical Images

Images hosted on other servers:

"Slapped cheek" appearance

Lace - like rash on extremities

Micro Description
  • Interstitial histiocytic infiltrate with piecemeal fragmentation of collagen and mononuclear cell-predominant vascular injury pattern
  • Extravasated red blood cells
  • Erythrocyte precursors may have intranuclear inclusions
  • Eosinophils and occasional neutrophils may be present
  • Perineuritis may also be present
  • Also interface dermatitis, eczematous alterations, papillary dermal edema; occasionally mesenchymal mucinosis, leukocytoclastic vasculitis
Micro Images

Images hosted on other servers:

Bone marrow

Fetal spleen

Parvovirus B19 infection in formalin - fixed and paraffin - embedded placenta and fetal tissues

B19 positive immunostain

Positive Stains
  • B19 immunostain
Molecular / Cytogenetics Description
  • Virus identified in endothelial cells of lesional skin by several methods, including PCR
  • Also identified in keratinocytes