Central nervous system (
CNS) vasculitis secondary to chronic parvovirus B19 (B19)
infection presenting with recurrent neurological findings is a very rare disorder during childhood. Here we report a 12-year-old boy with a renal transplant who had chronic B19
infection with skin eruptions and recurrent episodes of
encephalopathy with focal neurological deficits. B19
DNA was detected in blood, bone marrow, and skin biopsy specimens. Repeat cranial magnetic resonance (MR) imaging during each episode of
encephalopathy showed variable focal findings, and MR angiography revealed vasculitic changes with narrowing of the cerebral arteries. We hypothesized that the
CNS vasculitis might be associated with the chronic B19
infection. At the time of his fourth presentation with the same clinical findings, we administered
intravenous immunoglobulin (
IVIG) (1 g/kg per day, 2 consecutive days), which we continued for 6 months, at monthly intervals.
IVIG therapy resulted in remission and has been effective not only for the clearance of B19, but also for the improvement of clinical and radiological findings of
CNS vasculitis. We suggest that chronic B19
infection should be considered in immunocompromised patients with suspected
CNS vasculitis.
IVIG should be considered as a part of the treatment.