Parvovirus B19 infection can present with myriads of clinical diseases and syndromes; liver manifestations and hepatitis are examples of them. Parvovirus B19 hepatitis associated aplastic anemia and its coinfection with other hepatotropic viruses are relatively underrecognized, and there is sufficient evidence in the literature suggesting that B19 infections can cause a spectrum of liver diseases from elevation of transaminases to acute hepatitis to fulminant liver failure and even chronic hepatitis. It can also cause fatal macrophage activation syndrome and fibrosing cholestatic hepatitis. Parvovirus B19 is an erythrovirus that can only be replicate in pronormoblasts and hepatocytes, and other cells which have globosides and glycosphingolipids in their membrane can also be affected by direct virus injury due to nonstructural protein 1 persistence and indirectly by immune mediated injury. The virus infection is suspected in bone marrow aspiration in cases with sudden drop of hemoglobin and onset of transient aplastic anemia in immunosuppressed or immunocompetent patients and is confirmed either by IgM and IgG positive serology, PCR analysis, and in situ hybridization in biopsy specimens or by application of both. There is no specific treatment for parvovirus B19 related liver diseases, but triple therapy regimen may be effective consisting of immunoglobulin, dehydrohydrocortisone, and cyclosporine. 1. Background Parvoviridae family includes many pathogenic animal viruses including adeno-associated viruses which appear to infect humans without causing clinical manifestations. Most parvoviruses depend upon the help from host cells or other viruses to replicate, whereas only few (autonomous) parvoviruses propagate in actively dividing cells. Parvovirus B19 (B19) is the type member of the erythrovirus genus which propagates primarily in erythroid progenitor cells [1]. B19 can infect erythroid precursors, hepatocytes, and other cells that possess globosides and glycosphingolipids in their cell membrane, but it can only replicate in the erythroid precursors and few other cells including fetal liver, isolated stem and bone marrow cells, and megakaryocytic leukemia cell lines maintained with erythropoietin [2, 3]. Infection of parvovirus B19 is globally prevalent with infection being very common among children. The virus spreads primarily through respiratory droplets, and secondary infection is by household contacts. It can also be transmitted as nosocomial infections and by blood products. B19 is resistant to heat inactivation and organic detergent, because of
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