1. Recurrent parvovirus B19 infection-associated pure red cell aplasia in a kidney transplant patient
- Author
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Jaeseok Yang, Sooyong Park, Jongwon Ha, Yoon Hwan Chang, Sujin Gang, and Joonshik Hong
- Subjects
medicine.medical_specialty ,Thymoglobulin ,business.industry ,Anemia ,medicine.medical_treatment ,Pure red cell aplasia ,Immunosuppression ,urologic and male genital diseases ,medicine.disease ,Gastroenterology ,Tacrolimus ,Transplantation ,medicine.anatomical_structure ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Bone marrow ,business ,Kidney transplantation - Abstract
Posttransplant anemia is a common complication after kidney transplantation. Parvovi rus B19 (PVB19) infection can induce pure red cell aplasia (PRCA) in immunosuppressed transplant patients. We herein report a case of recurrent PVB19-associated PRCA in a kidney transplant patient. A 49-year-old woman presented with anemia and normal renal function 1 year after a deceased-donor kidney transplantation for immunoglobulin A ne phropathy-related end-stage renal disease. She received desensitization therapy, and 2 years later, she underwent transplantation with thymoglobulin induction. Despite repeat ed red cell transfusion and erythropoietin therapy, her anemia aggravated progressively. Bone marrow biopsy revealed normocytic normochromic PRCA. Real-time polymerase chain reaction detected a high plasma load of PVB19. Administration of intravenous im munoglobulin (IVIG) at 2 g/kg with adjuvant reduction of tacrolimus and discontinuation of myfortic acid effectively treated the anemia. However, the PVB19 load remained high, and PRCA recurred 7 months after the initial IVIG treatment. Tacrolimus was switched to cyclosporine in the second IVIG treatment, which successfully improved PRCA and reduced the PVB19 load. Our case suggested that PVB19-associated PRCA should be suspected when persistent anemia is observed in kidney transplant patients with heavy immunosuppression and that PVB19-associated PRCA can recur in the presence of per sistent PVB19 viremia.
- Published
- 2020