Severe parvovirus B19 encephalitis after renal transplantation

Abstract

Human parvovirus B19 is a common cause of benign erythema infectiosum (fifth disease) in otherwise healthy children. Immunocompromized patients are at risk of developing chronic infections leading to chronic hyporegenerative anemia. We report the case of a nine-year-old boy who presented five days after renal transplantation with seizures and signs of encephalitis on MRI. The clinical course was characterized by anemia and seroconversion for parvovirus B19 accompanied by a high viral load (>10(9) copies per milliliter). A transfusion of red blood cells that the patient required after transplantation was found to be negative for parvovirus B19, leaving the donated organ as the most likely source of infection. Reduction of the immunosuppressive regimen led to complete recovery of the patient with a stable RBC count upon discharge. Parvovirus B19 infections should be considered in the differential diagnosis of seizures after solid organ transplantation.

Neurologic Manifestations Associated with Parvovirus B19 Infection

“…Twenty-five patients (64%) were immunocompetent (mean age, 14.9 years), and 14 (36%) had altered immunity (mean age, 15.1 years). Ten (26%) had rash [6, 7, 9, 13-16, 18, 58], and 3 (8%) had arthralgia or arthritis [11,18,57]. Mental status changes occurred in 19 (49%), coma occurred in 6 (15%), seizures occurred in 18 (46%), and status epilepticus occurred in 4 (10%) (table 5).…”

“….001 Radiologic studies. In cases of encephalopathy and/or encephalitis or meningoencephalitis, magnetic resonance imaging often revealed diffuse increased signal in the white matter of the frontal or parietal lobes or periventricularly on T2-weighted or fluid-attenuated inversion recovery images [17,19,23,52,55,57], in the gray matter [52,55,57], brainstem [19,56], basal ganglia [19,52,59] or corpus callosum [9,23]. Enlarged ventricles were also detected [17].…”

Parvovirus B19 and the Kidney

“…Furthermore, neutropenia, thrombocytopenia, or pancytopenia may occasionally accompany the anemia, further broadening the differential diagnosis (77). Other clinical complications that have been linked with B19 infection in renal transplant recipi-ents include liver dysfunction (84), fibrosing cholestatic hepatitis (85), encephalitis (86), and cerebral vasculitis (87). However, causality has been difficult to infer in many cases.…”

Acute Transverse Myelitis Associated With Human Parvovirus B19 Infection

“…Furthermore, parvovirus B19 can occasionally cause other conditions such as hydrops fetalis, arthritis, hepatitis, and meningoencephalitis. [1][2][3][4][5] However, only a few cases of acute transverse myelitis due to parvovirus B19 have been reported. 6,7 We report a case of severe acute transverse myelitis associated with parvovirus B19 in which the parvovirus B19 primary infection was confirmed serologically and parvovirus B19 DNA was detected not only in serum but in the cerebrospinal fluid.…”