ORIGINAL ARTICLE Different patterns of skin manifestations associated with parvovirus B19 primary infection in adults Valentia Mage, MD, a Dan Lipsker, MD, PhD, b S ebastien Barbarot, MD, PhD, c Didier Bessis, MD, PhD, d Olivier Chosidow, MD, PhD, e Pascal Del Giudice, MD, f S elim Aractingi, MD, PhD, a J er^ ome Avouac, MD, g Claire Bernier, MD, c Vincent Descamps, MD, PhD, h and Nicolas Dupin, MD a Paris, Strasbourg, Nantes, Montpellier, Cr eteil, and Fr ejus, France Background: Skin involvement is reported during primary parvovirus B19 infection in adults. Objectives: We sought to describe the cutaneous presentations associated with parvovirus B19 primary infection in adults. Methods: We conducted a descriptive, retrospective, multicenter study. The patients included ( [18 years old) had well-established primary infections with parvovirus B19. Results: Twenty-nine patients were identified between 1992 and 2013 (17 women, 12 men). The elementary dermatologic lesions were mostly erythematous (86%) and often purpuric (69%). Pruritus was reported in 48% of cases. The rash predominated on the legs (93%), trunk (55%), and arms (45%), with a lower frequency of facial involvement (20%). Four different but sometimes overlapping patterns were identified (45%): exanthema, which was reticulated and annular in some cases (80%); the gloves-and-socks pattern (24%); the periflexural pattern (28%); and palpable purpura (24%). Limitations: The limitations of this study were its retrospective design and possible recruitment bias in tertiary care centers. Conclusion: Our findings suggest that primary parvovirus B19 infection is associated with polymorphous skin manifestations with 4 predominant, sometimes overlapping, patterns. The acral or periflexural distribution of the rash and the presence of purpuric or annular/reticulate lesions are highly suggestive of parvovirus B19 infection. ( J Am Acad Dermatol http://dx.doi.org/10.1016/j.jaad.2014.02.044.) Key words: exanthema; gloves and socks; infection; parvovirus B19; pruritus; purpura; virus. P arvovirus B19 is a single-stranded DNA virus from the Parvoviridae family. In temperate climates, infections with this virus are most frequent in the winter and spring. The virus is spread by droplets of fluid from the respiratory system and the frequency of secondary cases among household contacts is very high. 1 Parvovirus B19 is common worldwide, and seroprevalence increases with age (15% of preschool children, 50% of young adults, and about 85% of the elderly). Parvovirus B19 infection in children causes typical erythema infectiosum, also known as fifth disease; hydrops fetalis; and crises of hemolytic aplastic anemia in patients with chronic hemolytic anemia. 1 Parvovirus B19 may be respon- sible for up to 35% of all rashes associated with fever. 2 However, primary infection is asymptomatic From Service de Dermatologie, H^ opital Cochin, Assistance Publique des H^ opitaux de Paris (APHP), et Universit e Ren e Descartes, Paris a ; Facult e de M edecine, Universit e de Strasbourg et Service de Dermatologie, Centre Hospitalier R egional Universitaire (CHRU) b ; Service de Dermatologie, Centre Hospitalo-Universitaire (CHU) de Nantes c ; Service de Dermatologie, CHU de Montpellier d ; Service de Dermatologie, H^ opital Henri Mondor, APHP et Universit e Paris-Est Cr eteil (UPEC), Cr eteil e ; Service de Dermatologie, Centre Hospitalier (CH) de Fr ejus f ; Service de Rhumatologie, H^ opital Cochin, APHP, et Universit e Paris Descartes g ; and Service de Dermatologie, H^ opital Bichat Claude Bernard, Paris. h Funding sources: None. Conflicts of interest: None declared. Accepted for publication February 27, 2014. Reprint requests: Nicolas Dupin, MD, Service de Dermatologie, H^ opital Cochin, APHP, et Universit e Ren e Descartes, Pavillon Tarnier, 89 rue d’Assas, 75006 Paris. E-mail: nicolas.dupin@cch. aphp.fr. Published online April 10, 2014. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.02.044 1