Encephalopathy Associated with Chorea in Parvovirus B19 Infection: A Case Report

Background: The spectrum of neurological manifestations in children with parvovirus B19 infection is growing in recent years. Clinical Description: A 9-year-old child presented with a history of fever for 3 days, followed by weakness, confusion, unresponsiveness, and behavioral changes, with progressive worsening. He was hemodynamically stable with a power of 3/5, exaggerated tendon reflexes, extensor plantar, with a normal fundus. Management and Outcome: Considering a case of acute febrile encephalopathy, the child was started on antibiotics. The cerebrospinal fluid (CSF) revealed lymphocytosis and raised protein. Later, the child developed intermittent chorea affecting the upper limbs. Brain imaging showed multifocal T2/ Fluid-attenuated inversion recovery (FLAIR) hyperintensities in subcortical/deep white matter, and CSF polymerase chain reaction (PCR) showed parvovirus B19 DNA. The patient was treated with intravenous methylprednisolone and immunoglobulin. The child improved gradually with restoration of speech and ambulation by 3–4 weeks of illness. At 1-month follow-up, the child had fully recovered with no residual neurological deficits. Conclusion: Parvovirus-B19 infection may be considered a possible etiology in children with acute febrile encephalopathy, especially when associated with atypical extrapyramidal movement disorders. Early immunotherapy can lead to complete recovery.