Unmasking parvovirus B19: An atypical case of hepatitis with rash and arthralgia

Parvovirus B19 is a common virus, typically known for causing erythema infectiosum in children and polyarthritis in adults. In rare cases, parvovirus can cause hepatitis. We present the case of a 40-year-old previously healthy woman who presented with fever, fatigue, arthralgia, and a reticular erythematous rash. Physical examination revealed mild hepatomegaly and right upper quadrant tenderness. Further laboratory analysis was unremarkable except for elevated liver enzymes. Viral serologies for hepatotrophic viruses were negative, but parvovirus B19 IgM and IgG were positive and suggestive of parvovirus B19-induced hepatitis. In the medical literature, parvovirus B19 has been associated with acute and fulminant hepatitis, especially in immunocompromised patients. The outcomes can range from asymptomatic transaminase elevations to liver failure requiring transplantation. Nonetheless, our case highlights the possibility of atypical infection with no hematological abnormalities. It is important to recognize and treat parvovirus B19 as a potential cause of hepatitis, regardless of classic presentations or hematological results. • Parvovirus B19 should be tested in cases of unexplained elevated liver enzymes, especially when accompanied by rash and arthralgia. • Parvovirus B19-induced hepatitis can occur even in the absence of hematologic abnormalities, making early diagnosis difficult but crucial. • It would be beneficial to test for parvovirus B19V antibodies even after a diagnosis of autoimmune hepatitis is established, as this can alter management.