Parvovirus B19 Infection with Positive Rumpel-Leede Sign

A 49-year-old Japanese female nursery teacher with no known medical history presented with fever, myalgia, and rash. Six days previously, fever, chill, and moderate pain in the bilateral thighs and lower back had developed, followed 3 days later by exanthema containing urticaria-like wheal, maculopapular rash, and lace-like rash at the bilateral lower limbs and left upper limb. Two days before presentation, the rash expanded to the abdomen. By the next day the rash and fever had alleviated but bilateral swelling of the fingers developed, and pain in the lower limbs and back persisted.