Fulminant parvovirus infection following erythropoietin treatment in a patient with acquired immunodeficiency syndrome

We report the case of a 41-year-old black man with acquired immunodeficienc y syndrome who developed a severe chronic anemia due to parvovirus infectio n. Bone marrow biopsy revealed erythroid aplasia. The infectious nature of the anemia was not recognized, and the patient was treated with erythropoie tin. The patient's reticulocyte response was inadequate, however, and he re mained anemic. A second bone marrow biopsy showed erythroid hyperplasia and prominent intranuclear parvovirus inclusions within erythroid progenitors. Erythropoietin was discontinued and was followed by a course of intravenou s immunoglobulin, which resulted in rapid correction of anemia. To our know ledge, this is the first reported case of fulminant human parvovirus infect ion exacerbated by erythropoietin administration and documented by sequenti al bone marrow histologic examination. This case illustrates the critical i mportance of considering parvovirus in the etiology of chronic anemia with erythroid aplasia in immunocompromised patients.