Human parvovirus B19 infection in a renal transplant recipient: a case report

Herein we report a kidney transplant recipient, who was unresponsive to treatment of severe anemia, and presented hypocellular hematopoietic marrow, megaloblastosis and hypoplasia of erythroid lineage with larger cells with clear nuclei chromatin and eosinophilic nuclear inclusions. This patient was seropositive for Epstein-Barr and Cytomegalovirus infections and negative for anti-parvovirus B19 IgM and IgG antibodies, although symptoms were suggestive of parvoviruses infection. A qualitative polymerase chain reaction testing for B19 in serum sample revealed positive results for B19 virus DNA.This case report suggests that the diagnostic process for parvovirus B19 in renal transplant recipients should include a polymerase chain reaction assay to detect B19-DNA, since specific serological tests may be unreliable given their impaired humoral responses. These results also indicate the importance of considering parvovirus B19 infection in the differential diagnosis of persistent anemia in transplanted patients.The parvovirus (erythrovirus) B19 is a common human infection worldwide. The clinical manifestations of B19 infection depend on the host’s haematological status and immune responses [1]. In immunocompetent individuals, B19 causes the erythema infectiosum, also known as “fifth” disease. Classically, erythema infectiosum affects children who develop rash, fever and malaise, while in adults it may be associated with acute symmetrical polyarthropathy. B19 infection during pregnancy is associated with hydrops fetalis. In patients with chronic haemolytic anaemia, it correlates with transient aplastic crisis. In addition, it may also cause chronic anemia and pure red cell aplasia in immunocompromised patients [1,2].The cellular receptor for B19 is a globoside (P antigen), present in erythroid precursor cells. The virus infects, replicates in, and then lyses erythroid progenitor cells [1]. This direct effect on erythroid cells manifests characteristically as pure red cell