title: A case of persistent anemia in a renal transplant recipient: association with parvovirus B19 infection.
abstract: We report an unexplained anemia that persisted for 4 months in a renal transplant patient who was receiving immunosuppression therapy that included prednisolone, tacrolimus and azathioprine. A bone marrow biopsy demonstrated pure erythroid hypoplasia and occasional giant pronormoblasts with intranuclear inclusions, characteristic of a parvovirus B19 infection. Both the serum and bone marrow cells were positive by parvovirus B19 DNA PCR. The anemia resolved 6 weeks after the administration of intravenous immunoglobulin (IVIG). Four months later, anemia redeveloped and IVIG was infused again. Hemoglobin levels were, however, still subnormal after 1 month of treatment and tacrolimus was then switched to cyclosporin A, resulting in a clear improvement. A parvovirus B19 infection should be included in the differential diagnosis of renal transplant recipients who present with anemia associated with a low reticulocyte count. Tacrolimus may possibly impair the clearance of a parvovirus B19 infection.
authors.affiliation: Department of Internal Medicine, Ulsan University College of Medicine, Seoul, South Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sang-Pil
authors.initials: SP
authors.lastname: Chang
authors.forename: Jong-chul
authors.initials: JC
authors.lastname: Won
authors.forename: Jun-Seung
authors.initials: JS
authors.lastname: Lee
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Chi
authors.forename: Won-Seok
authors.initials: WS
authors.lastname: Yang
authors.forename: Su-Kil
authors.initials: SK
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010322:Parvoviridae Infections / Q000150:complications*; D016732:Parvovirus B19, Human; D012010:Red-Cell Aplasia, Pure / Q000188:drug therapy* / Q000209:etiology*; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus