Korean J Nephrol.  2001 Jul;20(4):707-713.

A Case of Persistent Anemia in a Renal Transplant Patient - Parvovirus B19 Infection

• Choi SH
• Chang SP
• Won JC
• Lee JS
• Yang WS
• Chi HS
• Park SK

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 for a parvovirus B19 DNA polymerase chain reaction. The anemia resolved 6 weeks after the administration of IV immunoglobuln. But, 4 months later, refractory anemia developed and persisted despite treatment with IV immunoglobulin. However, the patient showed rapid improvement after tacrolimus was switched to cyclosporin A. A parvovirus B19 infection should be included in the differential diagnosis of renal transplant recipients who present with an anemia associated with low reticulocytes; and clinicians should be awared that tacrolimus may impair the clearance of a parvovirus B19 infection.

Keyword

Parvovirus B19; Kidney transplantation; Pure red cell aplasia; Tacrolimus; Intravenous immunoglobulins

MeSH Terms

Anemia*
Anemia, Refractory
Azathioprine
Biopsy
Bone Marrow
Bone Marrow Cells
Cyclosporine
Diagnosis, Differential
DNA
Erythroblasts
Humans
Immunoglobulins
Immunoglobulins, Intravenous
Immunosuppression
Intranuclear Inclusion Bodies
Kidney Transplantation
Parvovirus*
Polymerase Chain Reaction
Prednisolone
Red-Cell Aplasia, Pure
Reticulocytes
Tacrolimus
Transplantation
Azathioprine
Cyclosporine
DNA
Immunoglobulins
Immunoglobulins, Intravenous
Prednisolone
Tacrolimus