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Osteoarthritis
2%
1/46
Parvovirus
4%
2/46
Reactive arthritis
54%
25/46
Rheumatoid arthritis
15%
7/46
Transient synovitis
20%
9/46
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This patient's presentation of symmetric arthritis of the hands, knees, and ankles in the context of a preceding cold-like illness and symptoms that spontaneously resolve suggest a diagnosis of a parvovirus B19 infection. Arthritis is a relatively uncommon manifestation of parvovirus B19 infection in children; however, the majority of adults with the infection develop arthralgias and a nonspecific viral syndrome that self resolves. The distribution of the arthritis is symmetric (most commonly involving the PIP and MCP joints in addition to the knees, wrists, and ankles) and may resemble rheumatoid arthritis. The arthritis is often self resolves within weeks but may last for months to years in some instances. Pediatric manifestations of parvovirus may include erythema infectiosum (or fifth disease which presents with a "slapped-cheek" appearance and fever) and an aplastic crisis (in sickle cell disease or hereditary spherocytosis with severe anemia and a low reticulocyte count). Incorrect Answers: Answer 1: Osteoarthritis presents with joint pain typically in an overweight/elderly individual that is worse with exertion and that gets progressively worse in a weight-bearing joint. It does not spontaneously resolve, and it is not associated with a viral syndrome. Answer 3: Reactive arthritis (Reiter syndrome) is secondary to a bacterial infection (typically, Chlamydia) that commonly manifests with a triad of arthritis, conjunctivitis, and urethritis. Answer 4: Rheumatoid arthritis presents with symmetric joint pain that is worse in the morning and improves throughout the day. It is associated with joint deformity and is not associated with a preceding viral illness or spontaneous resolution. Answer 5: Transient synovitis typically occurs in pediatric patient and presents after a viral illness with hip pain that spontaneously resolves. Children can usually bear weight on the joint in this condition in contrast to septic arthritis. Bullet Summary: Parvovirus in adults is associated with a viral syndrome and arthralgias that are symmetric that resolve on its own.
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