gms | German Medical Science

Human parvovirus B 19 is known as a virus causing erythema infectiosum, arthropathy, transient aplastic crisis and intrauterin fetal death. Healthy hosts are able to clear the virus within weeks after infection. There are a few reports available in the literature regarding immunocompromised renal transplant recipients with persistent infection without seroconversion. Herein, we describe a 56-year old woman with a history of grade II follicular lymphoma diagnosed in 2002 receiving the R-FC regimen, a combined immunochemotherapy consisted of rituximab, fludarabine and cyclophosphamide, for lymphoma relapse. She attained a partial remission and treatment was stopped after application of 5 cycles of R-FC. Complete regeneration of the peripheral blood counts up to 3 months after completion of treatment has been documented. 3 months later, the patient developed progredient anemia. She reported that she has experienced a episode of fever a few weeks before which was also accompanied by a maculopapulous exanthema. During the next weeks, the need for RBC transfusions increased to 2-3 Units every 10 days and, in addition, a severe leukocytopenia as well as an elevated LDH were observed. Differential diagnosis of relapsed follicular lymphoma disease was excluded by CT scan and bone marrow biopsy which revealed no evidence for lymphoma infiltration, but a moderate hypocellularity with no specific abnormalities. Measurement of serum immunoglobulin IgG and IgM antibodies were negative, but positive PCR analysis of peripheral blood and bone marrow aspirate were present for parvovirus B19. Treatment with IVIG treatment was initiated. A few days later, peripheral blood counts increased and finally normalized 7 weeks after onset of IVIG application. In summary, despite absence of classical bone marrow signs of pure red cell aplasia, e.g. occurrence of large pronormoblasts and hemophagocytosis as well as negative IgG and IgM parvovirus B19 antibodies, it is important to consider that (I) parvovirus B19 infection is a possible cause of progressive anemia and (II) of leukocytopenia in B-cell lymphoma patients treated with rituximab-combined chemotherapy. (III) Rituxmab plus fludarabine/ cyclophos-phamide induced a prolonged immunosuppression. (IV) High-titer immunoglobulin may enable eradication of parvovirus B19 in such patients before sufficient immune system reconstruction.