Pure red cell aplasia caused by Parvovirus B19 infection in solid organ transplant recipients: a case report and review of literature

Human Parvovirus B19 (PV B19) is one of the several recently described 'eme rging viruses' and has been identified as the etiological agent of 'fifth d isease' in childhood. Human PV B19, which is the etiological agent of trans ient erythroblastopenia in hemolytic anemia, is also a recognized rare caus e of red cell aplasia in immunocompromised patients, including transplant r ecipients. To date, 26 cases of PV B19-induced red cell aplasia have been r eported in solid organ transplant recipients. Twelve patients had cyclospor ine-based immunosuppression and 14 had tacrolimus-based immunosuppression. Sixteen of these patients required treatment with commercial intravenous im munoglobulin alone, 1 required treatment with intravenous immunoglobulin an d plasmapheresis, 4 required intravenous immunoglobulin and erythropoietin, 1 required treatment with intravenous immunoglobulin and conversion of tac rolimus to cyclosporine, 1 had improvement in hematocrit with erythropoieti n alone and in 3 patients the disease was self-limiting. Herein, we report a case of pure red cell aplasia caused by acute PV B19 infection in a renal transplant recipient in whom the immunosuppressive regimen included predni sone, mycophenolate mofetil and tacrolimus and the red cell aplasia resolve d with discontinuation of mycophenolate mofetil.