Chronic autoimmune thrombopenia/neutropenia in a boy with persistent parvovirus B19 infection.
OBJECTIVE
We report an 11-year-old boy presenting with splenomegaly, chronic thrombocytopenia and concordant neutropenia.


RESULTS
In contrast to autoantibodies against platelets, there were no detectable neutrophil-specific autoantibodies present in this patient. Extensive serologic investigations revealed increased IgM- and IgG-antibody titers against parvovirus B19. A nested polymerase chain reaction (PCR) showed parvovirus B19-specific sequences in the patient's bone-marrow cells but not in the serum. Specific antibodies against the structural proteins VP1 and VP2 in addition to those against non-structural protein NS1 of parvovirus B19 were detected by Western blot analysis. Thrombocytopenia and neutropenia responded to immunosuppressive therapy and subsequent splenectomy, the latter being necessary due to severe side-effects of steroid medication.


CONCLUSIONS
Autoimmune thrombocytopenia/neutropenia may have been triggered and/or sustained by a chronic parvovirus B19 infection. Patients with this very rare disorder should be screened for this virus.
Scheurlen
W
W
Universitäts-Kinderklinik Mannheim, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany. w.scheurlen@kikli.ma.uni-heidelberg.de
Ramasubbu
K
K
Wachowski
O
O
Hemauer
A
A
Modrow
S
S
D000914:Antibodies, Viral / Q000097:blood; D001327:Autoimmune Diseases / Q000628:therapy / Q000821:virology*; D015153:Blotting, Western; D002648:Child; D002908:Chronic Disease; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D009503:Neutropenia / Q000628:therapy / Q000821:virology*; D010322:Parvoviridae Infections / Q000188:drug therapy / Q000821:virology*; D016732:Parvovirus B19, Human / Q000187:drug effects / Q000472:pathogenicity*; D016133:Polymerase Chain Reaction; D012698:Serologic Tests; D013921:Thrombocytopenia / Q000628:therapy / Q000821:virology*
D000914:Antibodies, Viral; D007166:Immunosuppressive Agents