Severe Refractory Anaemia and Fever of Unknow Origin: Human Parvovirus B19 Reactivation

Abstract

Reactivation of human parvovirus B19 is exceptional and characteristic of immunosuppression, with anaemia being the predominant manifestation although pancytopenia and thrombotic microangiopathy may also occur. We describe a patient with a history of diffuse large B-cell lymphoma with pure erythrocyte aplasia due to reactivation of parvovirus B19, who was treated with corticosteroids and immunoglobulins.

Learning points: Infection with human parvovirus B19 is identified by polymerase chain reaction (PCR) testing of blood and the presence of typical giant proerythroblasts in the bone marrow.Cytomegalovirus infection should be considered in immunosuppressed patients with fever and non-specific symptoms with haematological changes.The treatment of persistent infection in immunosuppressed patients is based on the administration of IV immunoglobulins at high doses.

Keywords: Human parvovirus B19; pure red cell aplasia; viral reactivation.

Figure 1

Erythroid cells with signs of infection with parvovirus B19 (haematoxylin eosin, ×100)

Figure 2

Pronormo-erythroblasts with nuclear viral inclusion characteristic of infection by parvovirus B19 (haematoxylin eosin, ×400)