Pure red cell aplasia caused by parvovirus B19 infection in a female adolescent after renal

Martha Portillo-Carrillo; Luis Velásquez-Jones; Mara Medeiros-Domingo; Saúl Valverde-Rosas; Verónica Reséndiz-Núñez; Eunice Cuervo-Moreno; Teodoro Muñiz-Ronquillo; Gustavo Varela-Fascinetto; Benjamín Romero-Navarro

2006, Number 4

Bol Med Hosp Infant Mex 2006; 63 (4)

Pure red cell aplasia caused by parvovirus B19 infection in a female adolescent after renal

Portillo-Carrillo M, Velásquez-Jones L, Gómezchico-Velasco R, Medeiros-Domingo M, Valverde-Rosas S, Reséndiz-Núñez V, Cuervo-Moreno E, Muñiz-Ronquillo T, Varela-Fascinetto G, Romero-Navarro B

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ABSTRACT

Introduction. Parvovirus B19 can present in children as erythema infectious rash, aplastic anemia in patients with hemolytic diseases and pure red cell aplasia in immunocompromised patients, such as in bone marrow and solid organ transplant recipients.
Case report. A 15-year-old female with end stage renal disease of unknown origin received a renal transplant from a cadaveric donor. Two months after the transplant, she presented severe arregenerative anemia despite mofetil micofenolate withdrawal and required blood transfusions. IgM and IgG titers for parvovirus B19 were negative, but DNA polymerase chain reaction was positive. Bone marrow showed the characteristic pattern of pronormoblasts with megaloblastic changes and cytoplasmic vaculations, with maturation arrest at normoblast level. The patient was treated with intravenous immunoglobulin for 10 days with adequate reticulocyte response and resolution of her anemia.
Conclusions. Parvovirus B19 should be investigated in renal transplant patients with severe arregenerative anemia; DNA polymerase reaction test is the diagnostic test of choice. Treatment with intravenous immunoglobulin is the recommended therapy for the control and elimination of the infection and anemia resolution.

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