Pure red cell aplasia due to parvovirus B19 infection after liver transplantation: a case report and review of the literature.
Pure red cell aplasia (PRCA) due to parvovirus B19 (PVB19) infection after solid organ transplantation has been rarely reported and most of the cases were renal transplant recipients. Few have been described after liver transplantation. Moreover, little information on the management of this easily recurring disease is available at present. We describe the first case of a Chinese liver transplant recipient with PVB19-induced PRCA during immunosuppressive therapy. The patient suffered from progressive anemia with the lowest hemoglobin level of 21 g/L. Bone marrow biopsy showed selectively inhibited erythropoiesis with giant pronormoblasts. Detection of PVB19-DNA in serum with quantitative polymerase chain reaction (PCR) revealed a high level of viral load. After 2 courses of intravenous immunoglobulin (IVIG) therapy, bone marrow erythropoiesis recovered with his hemoglobin level increased to 123 g/L. He had a low-level PVB19 load for a 5-mo follow-up period without recurrence of PRCA, and finally the virus was cleared. Our case indicates that clearance of PVB19 by IVIG in transplant recipients might be delayed after recovery of anemia.
Liang
Ting-Bo
TB
Department of Hepatobiliary and Pancreatic Surgery, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, the First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
Li
Dong-Lin
DL
Yu
Jun
J
Bai
Xue-Li
XL
Liang
Liang
L
Xu
Shi-Guo
SG
Wang
Wei-Lin
WL
Shen
Yan
Y
Zhang
Min
M
Zheng
Shu-Sen
SS
D000328:Adult; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D004279:DNA, Viral / Q000097:blood; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D010322:Parvoviridae Infections / Q000150:complications* / Q000209:etiology; D016732:Parvovirus B19, Human / Q000235:genetics; D012008:Recurrence; D012010:Red-Cell Aplasia, Pure / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D012307:Risk Factors
D004279:DNA, Viral; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents