CHRONIC ANEMIA AS A COMPLICATION OF PARVOVIRUS B19 INFECTION IN A PEDIATRIC KIDNEY-TRANSPLANT PATIENT

This is a report of unexplained anemia that persisted for 4 months in an adolescent renal transplant patient receiving immunosuppression tha t included prednisone, tacrolimus, and mycophenolate mofetil. This pat ient required monthly blood transfusions for fatigue, palpitations, an d hematocrit levels between 15% and 17%. In addition, his posttranspla nt course was notable for the development of insulin-dependent diabete s mellitus. While receiving low-dose prednisone, he was switched from tacrolimus to cyclosporin and tapered off insulin injections over the next 2 months. At 4.5 months post-transplantation, further diagnostic evaluation was suggestive of parvovirus B19 infection as the cause for our patient's chronic anemia. After testing negative for serum-specif ic parvovirus B19 IgM and IgG antibodies, parvovirus B19 infection was detected in blood by the polymerase chain reaction. Treatment with in travenous immunoglobulin (1 g/kg per day x 2 days) resulted in normali zation of both his reticulocyte count and hematocrit within 6 weeks. A t 4 months after receiving the immunoglobulin infusion, he has maintai ned a normal hematocrit level and stable renal function without requir ing further blood transfusions.