Korean J Transplant.  2020 Sep;34(3):199-203. 10.4285/kjt.2020.34.3.199.

Recurrent parvovirus B19 infection-associated pure red cell aplasia in a kidney transplant patient

Affiliations
  • 1Department of Surgery, Seoul National University Hospital, Seoul, Korea
  • 2Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
  • 3Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
  • 4Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 5Transplantation Center, Seoul National University Hospital, Seoul, Korea

Abstract

Posttransplant anemia is a common complication after kidney transplantation. Parvovirus 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 nephropathy-related end-stage renal disease. She received desensitization therapy, and 2 years later, she underwent transplantation with thymoglobulin induction. Despite repeated 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 immunoglobulin (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 persistent PVB19 viremia.

Keyword

Intravenous immunoglobulin; Kidney transplantation; Parvovirus B19 infection; Pure red cell aplasia
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