Successful treatment of severe aplastic anemia associated with human parvovirus B19 and Epstein‐Barr virus in a healthy subject with allo‐BMT

Abstract

Several reports have noted pancytopenia associated with Human parvovirus B19 (PVB19)or Ebstein-Barr virus (EBV) infections in patients who have no history of immunodeficiency. To our knowledge, we report the first case of severe aplastic anemia associated with both EBV and PVB19 infections in a previously healthy 22-year-old man. He was admitted to our hematology service due to anemia and thrombocytopenia. He had no symptoms or signs of infections of these viruses. His bone marrow biopsy revealed a hypocellular marrow. Specific IgM and IgG antibodies to EBV and PVB19 were elevated. EBV and PVB19 virus genomes were detected by PCR in the bone marrow nucleated cells and the peripheral blood lymphocytes. Two months after treatment with prednisone, acyclovir, and intravenous immune globulin (IVIg), the genomes of both these viruses disappeared. However, his transfusion requirement for platelet suspensions and packed red blood cells persisted. The patient underwent allogeneic bone marrow transplant (allo-BMT) and has had an enduring complete hematological response for 8 months. Am.

Dose‐by‐dose virological and hematological responses to intravenous immunoglobulin in an immunocompromised patient with persistent parvovirus B19 infection

“…In patients with chronic haemolysis or erythropoietic stress it can cause a transient but often severe red cell aplasia [Wong et al, 1993;Heegaard and Brown, 2002]. However, in immunocompromised patients such as solid organ transplant recipients [Moudgil et al, 1997;Wicki et al, 1997;Wong et al, 1999;Lui et al, 2001;Choi et al, 2002], human immunodeficiency virus (HIV)-infected [Yap, 1994;Ramratnam et al, 1995;Hung et al, 2001] and hematological malignancies [Azzi et al, 1993;Sharma et al, 2000;Kaptan et al, 2001;Castelli et al, 2002;Song et al, 2002;Isobe et al, 2004;Mouthon et al, 2005;Eid et al, 2006], PVB 19 infection can persist, resulting in pure red cell aplasia, chronic anemia and pancytopaenia [Heegaard and Brown, 2002].…”

Dynamics of Graft Function Measured by DNA-Technology in a Patient with Severe Aplastic Anemia and Repeated Stem Cell Transplantation

“…There are very few published data reporting parvovirus B 19 as a pathogen, associated with SAA in immunocompetent and otherwise healthy individuals [11–14], while it is known to induce prolonged bone marrow aplasia in immunosuppressed patients [15, 16]. Although the connection between SAA and viral infections (hepatitis viruses, EBV, CMV, parvovirus B 19, HHV-6, and HIV) has not yet been reliably documented, direct effect or immune-mediated mechanisms of bone marrow failure are discussed [11, 17]. An attempt to clarify the role of parvovirus B 19 in SAA was made by Qian et al in 2002 [18].…”

Parvovirus Associated Fulminant Hepatic Failure and Aplastic Anemia Treated Successfully With Liver and Bone Marrow Transplantation. A Report of Two Cases

“…Since no population-based data about the presence of HPV-B19 DNA in healthy subjects is available, studies with larger sample size are warranted before refuting association between HPV-B19 and FHF. Additionally, several reports in the literature have described AA secondary to HPV-B19 infection, including successful treatment with myeloablation and BMT (19)(20)(21). It would seem that in the appropriate clinical scenario of FHF with positive PCR for HPV-B19, especially without any other identifiable cause, causative association between HPV-B19 and FHF cannot be denied.…”