S.V. KHALIULLINA¹, V.A. ANOKHIN¹, D.E. DOLOVSKOVA²

 ¹Kazan State Medical University, Kazan

²Republican Clinical Hospital for Infectious Diseases, Kazan

  Contact details:

Khaliullina S.V. — MD, Professor of the Department of Pediatric Infections

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7 (843) 267-80-06, e-mail: svekhal@mail.ru

Parvovirus B19 (PVB19) infection is widespread; the seropositivity rate among the population increases with age and in people over 70 years of age it is 80–85% or more. There are several clinical variants of the course, which depend on the age, hematological and immune status of the patients. Children most often experience infectious erythema (fifth disease, «slapped cheek disease») with predominant skin lesions in the form of erythematous rashes on the cheeks and «lace-like» rash on the body and limbs. Other variants of exanthema associated with parvovirus B19 have also been described. Skin manifestations can be measles- and rubella-like in nature, the rash can be punctate, vesicular, but more often hemorrhagic. One of the variants of PVB19 infection, occurring with a hemorrhagic rash, is the so-called papular-purpuric «gloves-and-socks» syndrome (PPGSS). PPGSS is described as a self-limited acrodermatosis, manifested by painful itchy symmetrical erythema on the extremities. The skin process is usually accompanied by edema, mucous membrane lesions, lymphadenopathy (in 20%), subfebrile temperature (in more than 50%), anorexia (in 15%) and arthralgia (in 10%). Treatment of a patient with PPGSS does not involve etiotropic therapy. In most cases, a patient recover within 1–2 weeks, without consequences for health. It is necessary to take into account that a patient with PPGSS at the time of the rash, unlike a patient with infectious erythema, continues to remain contagious to others.

Key words: parvovirus infection, papular-purpuric gloves and socks syndrome.

REFERENCES

1. Macri A., Crane J.S. Parvoviruses. 2023, Jun 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
2. Sharipova E.V., Babachenko I.V., Mukomolova A.L. Clinical and laboratory features of parvovirus infection in children. Detskie infektsii. 2013, vol. 12, no. 1, pp. 5–7 (in Russ.).
3. Karami A., Hoseini S.L., Ramazani A., Emadi P., Gholami H., Hoseini S.M. Prevalence of Parvovirus B19 Infection by Serology and PCR in Pregnant Women Referring to Obstetrics and Gynecology Clinic. J. Nat. Med. Assoc., 2020, vol. 112 (1), pp. 91–96. DOI: 10.1016/j.jnma.2018.12.001.
4. Segura-Saint-Gerons R., Ceballos-Salobreña A., Gutiérrez-Torres P., González-Ruiz A., Gavilán-Fernández I., Martínez-Sahuquillo-Márquez A. Papular purpuric gloves and socks syndrome. Presentation of a clinical case. Med. Oral. Patol. Oral. Cir. Bucal, 2007, vol. 12, pp. 4–6.
5. Frühauf J., Massone C., Müllegger R.R. Bullous papular-purpuric gloves and socks syndrome in a 42-year-old female: molecular detection of parvovirus B19 DNA in lesional skin. J. Am. Acad. Dermatol, 2009, vol. 60 (4), pp. 691–695. DOI: 10.1016/j.jaad.2008.08.037
6. Kozlov P.V., Kuznetsov P.A., Leonova E.I., Konstantinova K.I. Non-immune hydrops fetalis. A modern view on the problems of epidemiology, pathogenesis, and perinatal outcome. Problemy reproduktsii, 2014, no. 6, pp. 83–87 (in Russ.). DOI: 10.17116/repro201420683-87
7. Jordan J.A. Identification of human parvovirus B19 infection in idiopathic nonimmune hydrops fetalis. Am. J. Obstet. Gynecol, 1996, vol. 174 (1), pp. 37–42.
8. Harel L., Straussberg I., Zeharia A., Praiss D., Amir J. Papular purpuric rash due to parvovirus B19 with distribution on the distal extremities and the face. Clin. Inf. Dis, 2002, vol. 35 (12), pp. 1558–1561. DOI: 10.1086/344773
9. Naides S.J. Rheumatic manifestations of parvovirus B19 infection. Rheum. Dis. Clin. North Am, 1998, vol. 24, pp. 375–401.
10. Harms M., Feldmann R., Saurat J.H. Papular-purpuric “gloves and socks” syndrome. J. Am. Acad. Dermatol, 1990, vol. 23, pp. 850–854.
11. Bagot M., Revuz J. Papular-purpuric “gloves and socks” syndrome: primary infection with parvovirus B19. J. Am. Acad. Dermatol, 1991, vol. 25, pp. 341–342.
12. Hakim A. Concurrent Henoch-Schonlein purpura and papular-purpuric gloves-and-socks syndrome. Scand. J. Rheumatol, 2000, vol. 29, pp. 131–132.
13. Lefrère J.J., Couroucé A.M., Soulier J.P., Cordier M.P., Guesne Girault M.C., Polonovski C., Bensman A. Henoch-Schonlein purpura and human parvovirus infection. Pediatrics, 1986, vol. 78, pp. 183–184.
14. Aractingi S., Bakhos D., Flageul B., Vérola O., Brunet M., Dubertret L., Morinet F. Immunohistochemical and virological study of skin in the papular-purpuric gloves and socks syndrome. Br. J. Dermatol, 1996, vol. 135, pp. 599–602.
15. Trattner A., David M. Purpuric “gloves and socks” syndrome: histologic, immunofluorescence, and polymerase chain reaction study. J. Am. Acad. Dermatol, 1994, vol. 30, pp. 267–268.
16. Edmonson M.B., Riedesel E.L., Williams G.P., DeMuri G.P. Generalized petechial rashes in children during a parvovirus B19 outbreak. Pediatrics, 2010, vol. 125 (4), pp. 787–792. DOI: 10.1542/peds.2009-1488
17. Pemira S.M., Tolan R.W.Jr. Mycoplasma pneumoniae infection presenting as bullous papular purpuric gloves and socks syndrome: novel association and review of the literature. Clin. Pediatr. (Phila), 2011, vol. 50 (12), pp. 1140–1143. DOI: 10.1177/0009922811414290
18. Paller A.S., Mancini A.J. Papular purpuric gloves and socks syndrome, available online: https://www.sciencedirect.com/topics/medicine-and-dentistry/papular-purpuric-gloves-and-socks-syndrome#:~:text=Papular%2Dpurpuric%20gloves%20and%20socks%20syndrome%20(PPGSS)%20is%20another,the%20spring%20and%20summer%20months
19. Smith P.T., Landry M.L., Carey H., Krasnoff J., Cooney E. Papular-purpuric gloves and socks syndrome associated with acute parvovirus B19 infection: case report and review. Clin. Inf. Dis, 1998, vol. 27, pp. 164–168.
20. Grilli R., Izquierdo M.J., Fariña M.C., Kutzner H., Gadea I., Martin L., Requena L. Papular-purpuric “gloves and socks” syndrome: polymerase chain reaction demonstration of parvovirus B19 DNA in cutaneous lesions and sera. J. Am. Acad. Dermatol, 1999, vol. 41 (5), pp. 793–796. DOI: 10.1016/s0190-9622(99)70027-7
21. Vázquez-Osorio I., Mallo-García S., Rodríguez-Díaz E., Gonzalvo-Rodríguez P., Requena L. Parvovirus B19 infection presenting concurrently as papular-purpuric gloves-and-socks syndrome and bathing-trunk eruption. Clin. Exp. Dermatol, 2017, vol. 42 (1), pp. 58–60. DOI: 10.1111/ced.13013
22. Sklavounou-Andikopoulou M., Iakovou M., Paikos S., Papanikolaou V., Loukeris D., Voulgarelis M. Oral manifestations of papular-purpuric ‘gloves and socks’ syndrome due to parvovirus B19 infection: the first case presented in Greece and review of the literature. Oral Dis, 2004, vol. 10, pp. 118–122.
23. Vág T., Sonkoly E., Kemény B., Kárpáti S., Horváth A., Ongrádi J. Familiar occurrence of papular-purpuric ‘gloves and socks’ syndrome with human herpes virus-7 and human parvovirus B19 infection. J. Eur. Acad. Dermatol. Venereol, 2004, vol. 18 (5), pp. 639–641. DOI: 10.1111/j.1468-3083.2004.00994.x
24. Pérez-Ferriols A., Martínez-Aparicio A., Aliaga-Boniche A. Papular-purpuric “gloves and socks” syndrome caused by measles virus. J. Am. Acad. Dermatol, 1994, vol. 30 (2), pp. 291–292. DOI: 10.1016/s0190-9622(08)81938-x
25. Vélez A., Fernández-de-la-Puebla R., Moreno J.C. Second case of papular-purpuric gloves-and-socks syndrome related to hepatitis B infection. Br. J. Dermatol, 2001, vol. 145 (3), pp. 515–516. DOI: 10.1046/j.1365-2133.2001.04387.x
26. van Rooijen M.M., Brand C.U., Ballmer-Weber B.K., Yawalkar N., Hunziker T.K. Medikamentös induziertes papulopurpurisches Gloves-and-socks-Syndrom [Drug-induced papular-purpuric gloves and socks syndrome]. Hautarzt, 1999, vol. 50 (4), pp. 280–283. DOI: 10.1007/s001050050902
27. Schmid D., Gabbe D., Wolnik C., Pietruschka W.D. 28-jährige Patientin mit Exanthemen an Händen und Füßen. Internist, 2006, vol. 48, pp. 1284–1288. DOI: 10.1007/s00108-006-1730-8
28. Parez N., Dehée A., Michel Y., Veinberg F., Garbarg-Chenon A. Papular-purpuric gloves and socks syndrome associated with B19V infection in a 6-year-old child. J. Clin. Virol, 2009, vol. 44 (2), pp. 167–169. DOI: 10.1016/j.jcv.2008.11.013
29. Chantrapitak J., Chuamanochan M. Papular-purpuric “gloves and socks” syndrome in parvovirus B19 infection. N. Engl. J. Med, 2024, vol. 390 (2), p. 165. DOI: 10.1056/NEJMicm2309953
30. Abu Rous F., Li Q., Guo Y. Renal infarction and papular-purpuric gloves and socks syndrome (PPGSS): rare extra-haematological manifestations of acute parvovirus B-19 infection. BMJ Case Rep, 2021, vol. 14 (7), p. 244021. DOI: 10.1136/bcr-2021-244021
31. Jaworek A.K., Sacha T., Woźniak-Knop M., Hałubiec P., Giza A., Wojas-Pelc A. Papular-purpuric «gloves and socks» syndrome in systemic mastocytosis treated with imatinib: a diagnostic challenge. Pol. Arch. Intern. Med, 2024, vol. 134 (6), p. 16730. DOI: 10.20452/pamw.16730
32. Sato A., Umezawa R., Kurosawa R., Kajigaya Y. Kansenshogaku Zasshi, 2002, vol. 76 (11), pp. 963–966. DOI: 10.11150/kansenshogakuzasshi1970.76.963
33. Singh P., Brickley S., Mannava K., Tausk F. Papular purpuric gloves and socks syndrome in a patient with previous SARS-CoV-2 infection. JAAD Case Rep, 2021, vol. 16, pp. 72–73. DOI: 10.1016/j.jdcr.2021.08.019
34. Scaparrotta A., Rossi N., Attanasi M., Petrosino M.I., Di Pillo S., Chiarelli F. A strange rash with “gloves and socks” distribution. Arch. Med. Sci, 2015, vol. 11 (4), pp. 908–910. DOI: 10.5114/aoms.2015.53315
35. Santonja C., Nieto-González G., Santos-Briz Á., Gutiérrez Zufiaurre Mde L., Cerroni L., Kutzner H., Requena L. Immunohistochemical detection of parvovirus B19 in “gloves and socks” papular purpuric syndrome: direct evidence for viral endothelial involvement. Report of three cases and review of the literature. Am. J. Dermatopathol, 2011, vol. 33 (8), pp. 790–795. DOI: 10.1097/DAD.0b013e318221bc41
36. Higashi N., Fukai K., Tsuruta D., Nagao J., Ohira H., Ishii M. Papular-purpuric gloves-and-socks syndrome with bloody bullae. J. Dermatol, 2002, vol. 29 (6), pp. 371–375. DOI: 10.1111/j.1346-8138.2002.tb00284.x
37. Fretzayas A., Douros K., Moustaki M., Nicolaidou P. Papular-purpuric gloves and socks syndrome in children and adolescents. Pediatr. Infect. Dis. J, 2009, vol. 28 (3), pp. 250–252. DOI: 10.1097/INF.0b013e31818cb289
38. Kappers W., Stevens G., Bruynseels P., van den Akker M. Papular purpuric gloves and socks syndrome because of a mycoplasma infection. J. Pediatr, 2018, vol. 194, pp. 258–260. DOI: 10.1016/j.jpeds.2017.10.050
39. Feldmann R., Wruhs M., Loader D., Steiner A. Papular-purpuric gloves and socks syndrome. J. Dtsch. Dermatol. Ges, 2015, vol. 13 (12), pp. 1286–1288. doi:10.1111/ddg.12824
40. Hsieh M.Y., Huang P.H. The juvenile variant of papular-purpuric gloves and socks syndrome and its association with viral infections. Br. J. Dermatol, 2004, vol. 151 (1), pp. 201–206. DOI: 10.1111/j.1365-2133.2004.05946.x
41. Michelerio A., Tchich A., Vassallo C., Brazzelli V. Atypical exanthem with acral involvement in adult patients associated with human herpesvirus 7 active replication: A case series. Front. Med. (Lausanne), 2023, vol. 10, p. 1144856. DOI: 10.3389/fmed.2023.1144856
42. Zelman B., Muhlbauer A., Kim W., Speiser J. A rare case of papular-purpuric «gloves and socks» syndrome associated with influenza. J. Cutan. Pathol, 2022, vol. 49 (7), pp. 632–637. DOI: 10.1111/cup.14213
43. Ozaydin V., Eceviz A., Sari Dogan F., Dogan A. An adult patient who presented to emergency service with a papular purpuric gloves and socks syndrome: a case report. Turk. J. Emerg. Med, 2016, vol. 14 (4), pp. 179–181. DOI: 10.5505/1304.7361.2014.92259
44. Kljaić Bukvić B., Blekić M. Papular-purpuric gloves and socks syndrome. Int. J. Dermatol, 2021, vol. 60 (6), pp. 769–770. DOI: 10.1111/ijd.15456
45. Passoni L.F., Ribeiro S.R., Giordani M.L., Menezes J.A., Nascimento J.P. Papular-purpuric “gloves and socks” syndrome due to parvovirus B19: report of a case with unusual features. Rev. Inst. Med. Trop. Sao Paulo, 2001, vol. 43 (3), pp. 167–170. DOI: 10.1590/s0036-46652001000300010
46. Zhao Z., Wallace M.M., Zwerner J.P. A unique variant of juvenile papular-purpuric gloves and socks syndrome. Pediatr. Dermatol, 2020, vol. 37 (6), pp. 1179–1180. DOI: 10.1111/pde.14338
47. Nishimura Y., Ueda T. Papular purpuric gloves and socks syndrome in a 72-year old woman. IDCases, 2020, vol. 20, p. 00752. DOI: 10.1016/j.idcr.2020.e00752
48. Gutermuth J., Nadas K., Zirbs M., Seifert F., Hein R.., Ring J., Brockow K. Papular-purpuric gloves and socks syndrome. Lancet, 2011, vol. 378 (9786), p. 198. DOI: 10.1016/S0140-6736(11)60554-0
49. Katta R. Parvovirus B19: a review. Dermatol. Clin, 2002, vol. 20 (2), pp. 333–342. DOI: 10.1016/s0733-8635(01)00013-4