Human Parvovirus B19-associated Early Postoperative Acquired Pure Red Cell Aplasia in Simultaneous Pancreas-kidney Transplantation: A Case Report

Overview

Journal World J Clin Cases

Publisher Baishideng Publishing Group

Specialty General Medicine

Date 2021 Mar 22

PMID 33748248

Citations 1

Authors

Hui Wang

Ying-Xin Fu

Wen-Li Song

Zhen Wang

Gang Feng

Jie Zhao

Ye-Qi Nian

Yu Cao

Affiliations

Soon will be listed here.

Abstract

Background: Acquired pure red cell aplasia (aPRCA) related to human parvovirus B19 (HPV B19) is rarely reported in simultaneous pancreas-kidney transplantation (SPKT) recipients; there has yet to be a case report of early postoperative infection. In this current study, we report the case of a Chinese patient who experienced the disease in the early postoperative period.

Case Summary: A 63-year-old man, with type 2 diabetes and end-stage renal disease, received a brain dead donor-derived SPKT. Immunosuppression treatment consisted of tacrolimus, prednisone, enteric-coated mycophenolate sodium (EC-MPS), and thymoglobulin combined with methylprednisolone as induction. The hemoglobin (Hb) level declined due to melena at postoperative day (POD) 3, erythropoietin-resistant anemia persisted, and reticulocytopenia was diagnosed at POD 20. The bone marrow aspirate showed decreased erythropoiesis and the presence of giant pronormoblasts at POD 43. Metagenomic next-generation sequencing (mNGS) of a blood sample identified HPV B19 infection at POD 66. EC-MPS was withdrawn; three cycles of intravenous immunoglobulin (IVIG) infusion therapy were administered; and tacrolimus was switched to cyclosporine. The HPV B19-associated aPRCA resolved completely and did not relapse within the 1-year follow-up period. The diminution in mNGS reads was correlated with Hb and reticulocyte count improvements.

Conclusion: HPV B19-associated aPRCA can occur at an early period after SPKT. An effective therapy regimen includes IVIG infusion and adjustment of the immuno-suppressive regimen. Moreover, mNGS can be used for the diagnosis and to reflect disease progression.

Citing Articles

Parvovirus B19 status in liver, kidney and pancreas transplant candidates: A single center experience.

Simunov B, Mrzljak A, Jurekovic Z, Zidovec Lepej S, Bainrauch A, Pavicic Saric J World J Transplant. 2022; 12(11):378-387.

PMID: 36437842 PMC: 9693899. DOI: 10.5500/wjt.v12.i11.378.

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