Long-term remission of recurrent severe anemia as a result of parvovirus B19 infection in a pediatric renal transplant recipient.
We studied a case of recurrent PV-B19-associated anemia in a renal transplant child with long-term remission induced by baseline immunosuppression adjusted and intensive IVIG therapy. This was a 15-yr-old boy. Seven wk after transplantation, he experienced acute rejection, which was treated with high-dose steroids, ATG, and plasmapheresis. Ten wk after transplantation (three wk after rejection), his hemoglobin dropped to 54 g/L and serum PV-B19 PCR was positive. After therapy with IVIG and conversion from mycophenolate mofetil to rapamycin, anemia resolved. But the patient had fever on the fourth day of IVIG with mild pulmonary edema and rise in serum creatinine. Two months after the first course of IVIG, anemia recurred and a second course of IVIG (preadministration methylprednisolone) was given, which was followed by the resolution of anemia without side effect and recurrence two months later again. Baseline immunosuppression was adjusted with dual immunosuppression and low doses including prednisolone and tacrolimus. At the same time, monthly course of IVIG was repeated four times. Within the next 23 months, anemia did not recur and renal function remained stable. In conclusion, PV-B19-associated anemia can be recurrent in immunocompromised children and baseline immunosuppression should be carefully adjusted to control PV-B19 infection.
Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai, China.
Qian
Q
Shen
Hong
H
Xu
Qi
Q
Cao
Li-Jun
LJ
Zhou
Jin
J
Xu
Xiao-Yan
XY
Fang
Jie
J
Ge
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000740:Anemia / Q000209:etiology / Q000628:therapy / Q000821:virology*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010322:Parvoviridae Infections / Q000150:complications* / Q000628:therapy; D016732:Parvovirus B19, Human / Q000276:immunology / Q000302:isolation & purification*; D010956:Plasmapheresis / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014181:Transplantation Immunology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid