A 23-year-old woman comes to the physician because of a 3-day history of increasing pain and swelling of her hands and wrists. She has been unable to continue her daily activities like writing or driving. She has had a nonpruritic generalized rash for 4 days. She had a fever and a runny nose one week ago which resolved with over-the-counter medication. She is sexually active with a male partner and uses condoms inconsistently. She works as an attendant at an amusement park. Her temperature is 37.1°C (98.8°F), pulse is 90/min, and blood pressure is 118/72 mm Hg. Examination shows swelling and tenderness of the wrists as well as the metacarpophalangeal and proximal interphalangeal joints. Range of motion of the wrists is limited. A lacy macular rash is noted over the trunk and extremities. The remainder of the examination shows no abnormalities. Laboratory studies, including erythrocyte sedimentation rate and antinuclear antibody and anti-dsDNA serology, show no abnormalities. Which of the following is the most likely diagnosis?

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Quizplus · Accepted Answer

Eductional Objective: The disease typically manifests with mild febrile illness, occasionally followed by a maculopapular rash beginning on the perioral areas of the face several days later and spreading to the extremities from there. As the rash clears, it adopts a lacy and reticular pattern. Parvovirus B19 infection in adults may also manifest with symptoms of symmetric polyarthritis in the fingers, hands, knees, and ankles while the rash can be absent. The disease is usually self-limited and treatment is supportive, involving analgesics and NSAIDs. A short course of prednisone can be prescribed for parvovirus B19-associated arthritis.

A 23-Year-Old Woman Comes to the Physician Because of a 3-Day