Parvovirus B19 infection causing red cell aplasia in renal transplantationon tacrolimus

Parvovirus B19 infection is known to cause chronic anemia in immunocompromi sed hosts, including organ transplant recipients. Most reported cases of pa rvovirus B19-associated aplastic anemia in renal transplant recipients resp onded to intravenous immunoglobulin (IVIG) infusion, Tacrolimus is of speci al interest; it was proposed to be associated with pure red cell aplasia (P RCA) on its own because resolution of anemia on withdrawal of tacrolimus wa s previously observed, Interaction between parvovirus B19 infection and tac rolimus has not been reported, We report a case of parvovirus B19-associate d PRCA in a renal transplant recipient treated with tacrolimus who failed t o clear the virus despite repeated courses of IVIG. She showed complete rec overy promptly after tacrolimus was switched to cyclosporine A, A well-docu mented concomitant decrease in serum parvovirus DNA polymerase chain reacti on titer was also observed. This shows another mechanism by which tacrolimu s can aggravate PRCA because of impaired clearance of parvovirus B19 infect ion in transplant recipients. For those patients receiving tacrolimus who h ave parvovirus B19 infection with refractory anemia and who fail to recover with IVIG, replacement of tacrolimus with cyclosporine A can be considered , (C) 1999 by the National Kidney Foundation, Inc.