Archives ofDisease in Childhood Serological findings

Discussion In 1983, HPV-B19 was identified as the cause of erythema infectiosum by Anderson et al. I Therefore various pathological manifestations have been reported to be caused by HPV-B 19. Dijkmans et al detected HPV-B19 DNA in the synovial fluid of a 33 year old woman with arthritis.3 Saint-Martin et al reported a 1 year old boy with myocarditis caused by HPV-B 19.4 They found HPV-B19 structural proteins in the patient's myocardial tissue. In addition, aplastic crisis is a well known complication of HPV-B19 infection. Central nervous system involvement, as in encephalitis and aseptic meningitis, is a rare complication of HPV-B19 infection, and there have been only a few reports of central nervous system involvement associated with erythema infectiosum. Three case reports of encephalitis and one report of meningitis were found in a review of the recent literature.5 6 None of them, however, demonstrated direct evidence of central nervous system involvement by HPVB19. The detection of HPV-Bl9 DNA in the cerebrospinal fluid of our patient by the PCR suggests that central nervous system invasion by the virus had occurred. To the best of our knowledge, this is the first report ofthe detection of HPV-B19 DNA in cerebrospinal fluid of a patient with a serologically probed HPV-B19 meningitis. The prognosis of aseptic meningitis due to HPV-B19 appears to be good, judging from our experience and a previous case report. The widespread use of the PCR should help to determine the spectrum of HPV-B19 infection. Similar cases to ours will probably be detected and as yet unknown clinical manifestations may also be found.