A case of persistent anemia in a renal transplant recipient: association with parvovirus B19 infection.
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.
Choi
Sang-Ho
SH
Department of Internal Medicine, Ulsan University College of Medicine, Seoul, South Korea.
Chang
Sang-Pil
SP
Won
Jong-chul
JC
Lee
Jun-Seung
JS
Chi
Hyun-Sook
HS
Yang
Won-Seok
WS
Park
Su-Kil
SK
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
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus