Parvovirus B19 Infection in Solid Organ Transplantation: Report of A Case and A Review

Abstract

Infection with parvovirus B19 is common, with up to 55% of adults showing seropositive evidence of prior infection. Clinical disease can occur due to acute infection, chronic persistent viremia, rarely secondary infection, or possibly viral reactivation of latent virus. The clinical presentation of primary infection depends on age, the presence of a hematologic condition, and immune status. We report a renal transplant recipient who developed transfusion dependent anemia refractory to erythropoietin that responded to IgG replacement, although he had a relapsing course. It is an uncommon infection in solid organ transplant (SOT) recipients that has atypical features, usually presenting with pure red cell aplasia which is refractory to erythropoietin (EPO) and which can be transfusion dependent. Plasma polymerase chain reaction (PCR) measurement of DNA, both qualitative and quantitative, can be very helpful for diagnosis, but a negative test does not exclude infection. In those cases, bone marrow biopsy may be needed to document the viral infection. Due to immunosuppression, SOT recipients may not be able to mount a measurable antibody response; hence serologic diagnosis by antibody detection may be unreliable. Other end organ disease is even more unusual manifestation of parvovirus infection, but it can occur, most commonly in immunocompromised individuals. Intravenous immunoglobulin (IVIG) replacement therapy appears to be most effective treatment, although there may also be a role for reduction in immunosuppression. The ability to prevent this unusual infection may be difficult as most patients who transmit the disease are often asymptomatic.