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

Gang, Sujin; Park, Sooyong; Hong, Junshik; Chang, Yoon Hwan; Ha, Jongwon; Yang, Jaeseok

doi:10.4285/kjt.2020.34.3.199

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Gang et al reported a case of recurrent PB19‐related PRCA during 1‐year post‐renal transplantation, with 7 months duration between two anemic episodes. Although reducing tacrolimus with IVIG treatment improved the clinical condition at the first episode of anemia, ultimately switching from tacrolimus to cyclosporine improved the anemia and decreased the PB19 viral load 25 . Changing from tacrolimus to everolimus, a mTOR inhibitor, was found favorable for a KTR with recurrent anemia associated with chronic PB19 infection who did not first benefit from standard therapy 26 .…”

Section: Discussionmentioning

confidence: 99%

“…Although reducing tacrolimus with IVIG treatment improved the clinical condition at the first episode of anemia, ultimately switching from tacrolimus to cyclosporine improved the anemia and decreased the PB19 viral load. 25 Changing from tacrolimus to everolimus, a mTOR inhibitor, was found favorable for a KTR with recurrent anemia associated with chronic PB19 infection who did not first benefit from standard therapy. 26 However, Nowacka-Cieciura et al showed that the effectiveness of everolimus requires more studies.…”

Section: Discussionmentioning

confidence: 99%

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

Yaghoubi,

Dalil,

Tavakoli

et al. 2023

Clinical Case Reports

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Key clinical messagePB19 infection should be considered an uncommon cause of posttransplant anemia in renal transplant recipients, particularly those whose anemia is not associated with common etiologies. IVIG treatment and reduced immunosuppression could be beneficial.AbstractParvovirus B19‐associated relapsing anemia is rare in kidney transplant recipients. Herein, we report a case of relapsed anemia due to parvovirus B19 infection in a 53‐year‐old woman 18 months after kidney transplantation. The patient presented with palpitations, shortness of breath, dizziness, weakness, and lethargy. Early laboratory findings showed a WBC count of 6.000/μL, RBC count of 1.89/μL, hemoglobin (Hb) 3.5 g/dL, hematocrit (Hct) 15%, platelet count 266.000/μL, MCV 89, reticulocyte count 0.8%, and serum iron 221 μg/dL. Upon further evaluation, the RT‐PCR test for BK polyomavirus and cytomegalovirus (CMV) was negative, while the parvovirus B19 RT‐PCR was positive. The patient was treated with blood transfusion and IVIG 25 g daily for 5 days. Two months after discharge, the patient presented, complaining of palpitation, shortness of breath, and dizziness, with RBC 2.7/μL, Hb 6.5 g/dL, Hct 25%, and MCV 85. Again, the CMV RT‐PCR was negative, while the parvovirus B19 RT‐PCR was positive. Tacrolimus and mycophenolic acid were stopped, and IVIG 25 g daily for 5 days was administered. Consequently, her Hb level increased to 9 g/dL, and the patient was discharged with prednisolone 5 mg daily and cyclosporine 50 mg daily instead of tacrolimus. Viral infection, particularly PB19 infection, should be considered in the differential diagnosis of posttransplantation anemia in KTRs. IVIG treatment and modification of immunosuppressive medications are suggested standard therapies for such patients. The function of transplanted kidneys should be carefully monitored during treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Yaghoubi,

Dalil,

Tavakoli

et al. 2023

Clinical Case Reports

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“…Bei Immunsupprimierten treten insbesondere Zytopenien häufig auf. Die Ursachen dafür sind vielfältig, wobei die häufigsten Gründe Medikamentennebenwirkungen (bedingt durch Immunsuppression oder Toxizität) und/oder virale Infektionen sind [16,31] Im späteren Verlauf nach TX spielen auch hämatologische/onkologische Erkrankungen und Behandlungsregime eine Rolle. Exotisches Beispiel einer Anämie unter Immunsuppression ist die "Pure red Cell Aplasia" (isolierte, teils schwere Anämie) bei einer möglichen Parvovirus-B19-Infektion; aber auch hier sind mannigfaltige Ursachen (erworben/ Malignität/vererbt) möglich [31,32,33]…”

Section: Blutbildveränderungen: Zytopenienunclassified

Nierentransplantierte in der Notaufnahme: Allgemeines und Komplikationen

Köhnke,

Reuter

2024

Notaufnahme up2date

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Recurrent Parvovirus B19-Associated Pure Red Cell Aplasia: A Challenging Disease in Kidney Transplantation

Paulo,

Ferreira,

Cerqueira

et al. 2024

BJT

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Parvovirus B19 (PVB19)-associated pure red cell aplasia (PRCA) is an important diagnosis to consider in kidney transplant (KT) recipients experiencing persistent anemia, in whom other etiologies have been excluded. Its management poses a challenge since reducing immunosuppression (IS) to address the viral infection needs to be carefully balanced with the increased risk of allograft rejection. The authors describe a case of a 43-year-old male with a history of chronic kidney disease of unknown etiology who underwent a KT from a deceased donor after circulatory death in January 2021. In the 1st year post-KT, the patient was repeatedly admitted due to the recurrence of PVB19-associated PRCA, requiring blood transfusions and intravenous immunoglobulin (IVIG). IS was initially adjusted with mycophenolate mofetil (MMF) suspension and later transitioned to a TRANSFORM scheme with prednisolone, tacrolimus, and everolimus. Due to deteriorating kidney function, a kidney biopsy was performed and revealed borderline acute T-cell mediated rejection with significant signs of chronicity (50% of interstitial fibrosis and tubular atrophy). To guarantee infection control, IS was not increased. Considering the recurrence of PVB19-associated PRCA, despite the use of a TRANSFORM IS scheme in a patient with chronic allograft dysfunction and high immunologic risk, maintenance therapy with IVIG (0.4 mg/kg) every 4 weeks was started. After 9 months of maintenance therapy, no relapse was identified. To promote an individualized IS prescription, an ImmunoBiogram® was recently performed and an IS reduction is planned, followed by an ImmunoBiogram® control, which will potentially allow the suspension of IVIG maintenance therapy. The diagnosis and management of PVB19-associated PRCA is challenging. Regarding recurrent disease, prolonged IVIG treatment appears to be a useful treatment strategy, but more studies are necessary to ascertain its role. It is also fundamental to tailor the IS as much as possible to the individualized immunologic profile of the patients to prevent overimmunosuppression.

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

Cited by 4 publications

References 15 publications

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

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

Nierentransplantierte in der Notaufnahme: Allgemeines und Komplikationen

Recurrent Parvovirus B19-Associated Pure Red Cell Aplasia: A Challenging Disease in Kidney Transplantation

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