gms | German Medical Science

Background: Anemia commonly occurs in kidney transplant (KT) recipients. Anemia in these hosts is known to be associated with multiple factors such as iron deficiency, graft rejection, erythropoietin (EPO) deficiency, viral infection, immunosuppression therapies and infection prophylaxis medications.

Parvovirus B19 infection is known to cause chronic anemia in immunocompromised hosts. We report a case of parvovirus B19 infection-associated severe anemia in a KT recipient.

Case: An 11 years old female with chronic kidney disease (CKD) received KT from her mother. Her immediate post-transplant course had been uneventful and her hematocrit (Hct) level had been maintained around 30% and creatinine 0.66 mg/dL at discharge. However, she developed fever up to 38ºC for 2 days, general weakness and dizziness on post-KT day 44 and presented to emergency room.

Past medical history showed that she was diagnosed with CKD at the age of 6 years old. Her post-KT medication included EPO, vitamin D, amplodipine, carvediol, tacrolimus and ferrumate. Family history and social history were not significant.

Physical examination showed that she looked pale and had anemic sclerae. Laboratory studies showed normocytic normochromic anemia with Hct of 12.6% and creatinine 0.6 mg/dL. The patient’s condition improved with intravenous fluid hydration and antipyretics. She also received RBC transfusion and continued ferrumate and EPO 20000 IU/ml medications. She was discharged home with symptom improvement.

For the second admission, she came back with general weakness, dizziness and fatigue on post-KT day 62. The Hct level was 9.6%, creatinine 0.62 mg/dL and laboratory results did not show any evidence of reticulocytopenia, or positive Coomb’s test. She did not have any history of recent blood loss. At this point, the test result for parvovirus B19 PCR became available from previous hospitalization and it was detected as qualitatively positive on post-KT day 57. Parvovirus infection associated pure cell aplasia was suspected and intravenous immunoglobulin (IVIG) was given at a dose of 400 mg/kg/day for 14 days. Parvovirus viremia was controlled and the patient recovered from anemia.

Conclusion: Anemia is a common finding in patients with CKD. We observed a case that the parvovirus B19 infection caused serious life-threatening anemia in a KT recipients. IVIG was given and it successfully rescued the patient from serious anemia and controlled viremia.

Key words: parvovirus B19, kidney transplantation, Immune compromised host, anemia