Severe anemia caused by parvovirus B19 in a patient with functioning kidney transplant: case report

Abstract

Parvovirus B19 (PV B19) infection can cause pure red cell aplasia (PRCA) and severe normochromic anemia resistant to treatment with erythropoietin in renal transplant recipients. Active parvovirus infection usually develops in the first months after kidney transplantation (KT), but is not always accompanied by clinical symptoms. The incidence of PV B19-associated anemia is low - not more than 1–1.5 %. A confirmation of the etiology of the disease, in addition to the characteristic histological picture of the bone marrow (a decrease in the number of erythrokaryocytes of less than 5% with preserved myelopoiesis and megakaryopoiesis, the appearance of single giant pronormoblasts), is the detection of PV B19 DNA in the blood and / or bone marrow. The detection of specific IgM antibodies to parvovirus plays a less significant role in the diagnosis of active PV B19 infection in patients after KT receiving immunosuppressive therapy and should not be used as the only diagnostic method. There is no specific antiviral treatment for PV B19 infection, therefore other approaches to therapy are used: reduction of immunosuppression, transfusion of red blood cells, administration of intravenous immunoglobulin (IVIG). The article describes the clinical observation of a 33-year-old patient with stage 5 CKD who developed severe normochromic anemia resistant to treatment with erythropoietin 4 weeks after a successful KT. A cytological examination of the bone marrow revealed PRCA, and a large number of copies of PV B19 DNA were detected in the patient’s blood, while antibodies to parvovirus IgG and IgM were not revealed. A decrease of immunosuppression (withdrawal of mycophenolic acid), repeated administration of IVIG in a total dose of 147 g resulted to lasting normalization of red blood cells number and hemoglobin level after five months of treatment. The function of the renal transplant remained normal throughout the observation period.