CHRONIC PARVOVIRUS INFECTION MIMICKING MYELODYSPLASTIC SYNDROME IN A CHILD WITH SUBCLINICAL IMMUNODEFICIENCY

Purpose: We present a report of a child with subclinical immunodeficie ncy who became chronically infected with parvovirus resulting in pancy topenia and morphologic abnormalities in the bone marrow mimicking mye lodysplastic syndrome (MDS). Patient: An 8-year-old boy presented with severe anemia, moderate thrombocytopenia and granulocytopenia. The pa tient showed hyper-immunoglobulin M (IgM) immunedeficiency but no incr eased susceptibility to infections. The bone marrow was hypercellular with dysplastic granulocytopoiesis and erythroblastopenia. Results: Tr eatment with cyclosporine and i.v. Ig resulted in temporary normalizat ion of the hemoglobin level. For several years it was assumed that the patient had MDS, A diagnosis of parvovirus infection was initially re jected due to the lack of specific antibodies and the absence of giant pronormoblasts in the bone marrow. When the polymerase chain reaction technique became available, parvovirus DNA was detected from the enti re disease course. Conclusions: This case report expands our conceptio n of the clinical spectrum of parvovirus infection and emphasizes that parvovirus must be considered as a differential diagnosis in MDS. We recommend performing a parvovirus DNA test despite negative serologic findings in patients with MDS, especially when associated with immunol ogic abnormalities.