Parvovirus B19 infection-related complications in renal transplant recipients: treatment with intravenous immunoglobulin.
BACKGROUND
Chronic red cell aplasia can develop in immunocompromised patients including transplant recipients infected with parvovirus B19 (PV B19). Renal involvement with PV B19 infection is not well-recognized.


METHODS
We diagnosed erythroid hypoplasia associated with PV B19 infection in three renal transplant recipients; one of them developed de novo collapsing glomerulopathy. These patients were treated with intravenous immunoglobulin (IVIG).


RESULTS
In two patients, anemia responded promptly to IVIG therapy. One of them had recurrence of anemia that responded to a second course of IVIG. Despite IVIG treatment, persistent infection with PV B19, recurrent anemia, and de novo collapsing glomerulopathy leading to allograft failure developed in the third patient, who had received the most intense immunosuppression.


CONCLUSIONS
These findings indicate that PV B19 infection in transplant recipients can cause chronic red cell aplasia that generally responds to IVIG therapy. In some patients, particularly those who are heavily immunosuppressed, infection may persist despite treatment. As the cellular receptor for PV B19 is expressed in the kidney, persistent infection may result in development of glomerulopathies in these patients.
Moudgil
A
A
Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. amoudgil@mailgate.csmc.edu
Shidban
H
H
Nast
C C
CC
Bagga
A
A
Aswad
S
S
Graham
S L
SL
Mendez
R
R
Jordan
S C
SC
D000328:Adult; D000740:Anemia / Q000175:diagnosis / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007674:Kidney Diseases / Q000601:surgery / Q000821:virology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010322:Parvoviridae Infections / Q000150:complications*; D016732:Parvovirus B19, Human
D004279:DNA, Viral