Persistent anemia in a kidney transplant recipient with parvovirus B19 infection

Abstract

Anemia after kidney transplant is not uncommon. This paper reports a case of unexplained anemia in a kidney transplant recipient that persisted for more than two months, and that did not respond to recombinant human erythropoietin treatment but was successfully treated after diagnosing Parvovirus B19 (ParvoV B19) infection. A middle-aged male underwent living-unrelated kidney transplantation from Pakistan in April 2015. He was on triple immuno-suppression therapy consisting of prednisolone, tacrolimus, and mycophenolate mofetil. He presented with anemia which persisted for more than two months that did not improve with Darbepoetin alpha and required blood transfusions. A bone marrow biopsy demonstrated pure erythroid hypoplasia and occasional giant pronormoblasts characteristic of a ParvoV B19 infection. The serum was highly positive for ParvoV B19 DNA polymerase chain reaction. The anemia resolved completely three weeks after the administration of intravenous immunoglobulin. ParvoV B19 infection should be considered in the differential diagnosis of kidney transplant recipients who present with anemia associated with a low reticulocyte count.

Parvovirus: Uncommon Causes of Anemia and Kidney Failure in a Kidney Transplant Patient

“…The most common clinical manifestations of parvovirus in immunocompromised patients are arthralgia fever and anemia rash, and lack of response to erythropoietin (5). Parvovirus can be accompanied by hepatitis, myocarditis, pneumonitis, and graft dysfunction in transplant patients (3), as in our patient.…”

Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature

“…9 Fever, rash, arthralgia, normochromic normocytic anemia, and lack of response to erythropoietin are the most common manifestations of PB19 infection in immunosuppressed patients. 10 PB19 infection may involve other organs, leading to myocarditis, pneumonitis, hepatitis, and graft failure. 3,11 In our patient, the clinical suspicion of erythrocyte-involving infection, such as PB19, was raised due to the decrease in erythrocyte levels as well as the lack of evidence of common causes of anemia, including gastrointestinal or urinary bleeding, hemolysis, or malnutrition.…”

“…However, immunocompromised patients may experience persistent infection owing to insufficient antiviral antibody production, leading to pure red blood cells aplasia (PRCA) 9 . Fever, rash, arthralgia, normochromic normocytic anemia, and lack of response to erythropoietin are the most common manifestations of PB19 infection in immunosuppressed patients 10 . PB19 infection may involve other organs, leading to myocarditis, pneumonitis, hepatitis, and graft failure 3,11 .…”

“…Persistent unexplained anemia for 2 months after living kidney transplantation was diagnosed to be related to PB19 infection, confirmed by RT‐PCR and bone marrow biopsy. Three weeks IVIG treatment resolved the anemia completely 10 . Tiong et al reported a severe complication, splenic rupture, following IVIG treatment for persistent anemia due to PB19 infection.…”

Pure Red Cell Aplasia After Kidney Transplantation: Parvovirus B19 Culprit or Coincidence?

“…Boaek et al indicated deceased donor kidney transplantation, tacrolimus treatment, and decreased hemoglobin concentration as factors correlating significantly in multivariate analysis with PV B19 infection within the first-year after kidney transplantation [24]. Approximately 50 cases of PV B19 related PRCA in adult kidney recipients have been described in the literature to date [18,23,25–63], (see Table 3). PRCA was diagnosed from 4 days to 160 weeks after kidney transplantation, usually within the first year [25,59].…”