Aplastic anemia caused by parvovirus B19 infection in a kidney transplant receipient with systemic lupus erythematosus-case report
Hui-Kung Ting1, Yu-Cing Juho1, Yeu-Chin Chen2, Shou-Hung Tang1, Tai-Lung Cha1, Seng-Tang Wu1
Division of Urology1, Department of Surgery, Tri-Service General Hospital, National
Defense Medical Center, Taipei, Taiwan
Division of Hematology-Oncology2, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Anemia is common after kidney transplantation. Parvovirus B19 (PVB19) infection is a rare etiology of post-renal transplant anemia, which can induce significant anemia including pure red cell aplasia but the incidence is probably under estimated. The most common viral infections in patients with systemic lupus erythematosus (SLE) is also PVB19 and it may be related to a lack of anti-B19 antibodies. We report a kidney transplant recipient with SLE who presented with severe anemia unresponsive to erythropoietin (EPO) therapy. Bone marrow examination showed hypocellularity, decreased erythroid series with excess pronormoblasts, which suggests aplastic crisis by PVB19 infection. Polymer chain reaction (PCR) testing for PVB19 revealed positive result. The patient received intravenous immunoglobulin (IVIG) 0.4g/kg body weight daily for 5 doses. One week after treatment, her Hgb returned to normal but declined again 2 weeks later with evidence of persistent PVB 19 viremia by PCR. Differential diagnosis of anemia in transplanted patients should include PVB 19 infection especially when resistant to EPO therapy and lack of appropriate reticulocyte response. And screening for PVB19 should be included in recipients with SLE.