Successful Treatment of Anemia With Anaplastic and Microangiopathic Characteristics in a Kidney Transplant Recipient With Parvovirus B19 Infection: A Case Report.

Abstract Background The prevalence of parvovirus B19 infection in renal transplantation ranges from 2% to 30%. The age and immune status of the patient influence the severity of the clinical picture. A diagnosis is made by taking as evidence the giant proerythroblasts on a bone marrow sample and the parvovirus B19 viral replication with a polymerase chain reaction (PCR) technique at the blood level. Clinically, parvovirus B19 may appear with fever and severe anemia, which can be followed by pancytopenia and thrombotic microangiopathy in some cases. The literature reports a graft dysfunction rate ranging from 10% to 36%. An infection relapse may happen in 30% of cases. Case presentation We report the case of a 33-year-old patient who underwent a kidney transplant in January of 2018. After transplantation, he reached a creatinine value of 1.1 mg/dL and a hemoglobin (Hb) level of 14 g/dL. In April 2019, he developed mycoplasma pneumonia, with signs of hemolytic anemia on bone marrow aspiration. Eventually, he was admitted because of fever, arthralgia, and anemia, with serologic and bone marrow biopsy evidence of red cell aplasia secondary to parvovirus B19 infection. He was treated with 400 mg/kg intravenous immunoglobulin (IVIg) for 10 days; 18 days after the end of treatment, he reached a creatinine value of 1.15 mg/dL, an Hb of 12.5 g/dL, and a reduction of the viral load from 25,000,000 copies/mL to 1,600,000 copies/mL. Conclusions Anemia with both an aplasic and hemolytic component was successfully treated using immunoglobulin therapy, with a significant fall in the parvovirus B19 viral load.