Acute Periflexural Purpura as a Revealing Sign of Parvovirus B19 Infection in a Child

Purpura is a frequent dermatologic manifestation in children, arising from a broad spectrum of conditions ranging from benign viral infections to systemic disorders. Among viral causes, parvovirus B19 has been reported to occasionally induce purpuric eruptions in children, sometimes mimicking more severe hematologic or inflammatory disorders. Parvovirus B19 is classically associated with erythema infectiosum, but it can occasionally manifest with atypical cutaneous eruptions, including purpuric lesions in unusual distributions. We report the case of an 11-year-old child with no prior medical history who presented to the pediatric emergency department with a purpuric rash that had been evolving over a week and mild fever. Examination revealed purpuric petechial lesions, predominantly affecting the periflexural region, including the axillary and elbow folds, accompanied by a maculo-petechial enanthem. Laboratory studies showed leukopenia and neutropenia with mildly elevated C-reactive protein. Serology confirmed a primary parvovirus B19 infection based on positive IgM antibodies. The patient's condition resolved spontaneously within one week with symptomatic treatment. This case highlights that parvovirus B19 infection may present as acute periflexural purpura, broadening the known clinical presentation of the infection. Awareness of these atypical presentations is essential to prevent unnecessary diagnostic procedures and inappropriate therapies. Serological testing or PCR may be crucial for diagnosis and guiding patient management, ensuring accurate assessment and appropriate symptomatic care.