A case of pure red cell aplasia complicated by Evans syndrome

Abstract

A 33-year-old woman complaining of severe anemia was admitted to our hospital for polyclonal hyperglobulinemia. She was diagnosed with pure red cell aplasia (PRCA) associated with Evans syndrome. Initially, the presence of human parvovirus B19 (HPV B19) IgM appeared to indicate that the cause of PRCA was HPV B19 infection. Evans syndrome improved with steroid therapy, but PRCA was refractory. Cyclosporine was administered; consequently, the patient markedly recovered from PRCA and was discharged. PRCA complicated by Evans syndrome occurred during the course of polyclonal hyperglobulinemia. The most direct etiology for the onset of PRCA was unclear; however, immunological disorders such as polyclonal hyperglobulinemia, in addition to HPV B19 infection, may have been partly responsible for the etiology of PRCA.

Impact of parvovirus B19 infection on paediatric patients with haematological and/or oncological disorders

“…Furthermore, B19V‐infection is known to cause thrombocytopenia and to trigger autoimmune disorders [5,20–24]. We observed markers for acute or recent B19V‐infection in five patients presenting with autoimmune disease: ITP was diagnosed in patients AI and AII, Kawasaki‐disease in patient AIII, thrombocytopenia in patient AIV and Evan’s syndrome in patient A1, even though, contraversially, Kawasaki‐disease and Evan’s syndrome have been associated with B19V‐infection [25–27].…”

Double hit: Evans syndrome after malignant thymoma treatment and parvovirus B19 infection

“…We report a case of Evans syndrome in a patient likely triggered by his recently treated thymoma and active parvovirus B19 infection. Evans syndrome has been previously linked to both thymoma1 and parvovirus B19 infection 2 3. However, this is the first known case to involve both simultaneously in the development of Evans syndrome.…”

“…Through this mechanism, parvovirus B19 has the potential to trigger a variety of autoimmune diseases. There have been case reports of parvovirus B19 causing either AIHA or ITP,11–13 while Evans syndrome has also been reported 2 3 14…”

Association of Hemoglobin Electrophoretic Phenotype with Human Parvovirus B19 infection among Pregnant Women attending Abuja Tertiary Hospital, Nigeria

“…In individuals with normal hemoglobin, B19V infection is self-limiting and generally causes a rash or arthralgia preceded by subclinical erythroid aplasia (13). Nonetheless, in individuals with impaired erythrocytes production, B19V infection results in a severe drop of hemoglobin values, causing anemia which could be life threatening (13,14).…”