A Rare Case of Parvovirus B19 Infection Manifesting as Chronic Aplastic Anemia and Neutropenia in a Human Immunodeficiency Virus-Infected Patient

Shehi, Elona; Ghazanfar, Haider; Fortuzi, Ked; González, Efraín; Zeana, Cosmina

doi:10.7759/cureus.12174

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…The low Influenza A/H1N1 genome copy number in cardiac tissues associated with a significant PVB19 genome copy number supports the hypothesis of a reactivated PVB19-induced acute myocarditis during an Influenza A/H1N1 infection, as reported for other viruses associated with PVB19: CMV [ 26 ], HHV6 [ 27 ], EBV [ 28 ], HIV [ 29 ], and IAB [ 30 ]. However, PVB19 coinfection with Influenza A virus has not been reported.…”

Section: Discussionsupporting

confidence: 68%

Coinfection of Parvovirus B19 with Influenza A/H1N1 Causes Fulminant Myocarditis and Pneumonia. An Autopsy Case Report

et al. 2021

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Parvovirus-B19 (PVB19) is a frequent causative agent of myocarditis. For unclear reasons, viral reactivation can cause acute myocarditis, a leading cause of sudden death in the young. Influenza A/H1N1(2009) virus (IAV/H1N1) is known for causing flu/pneumonia, but the heart is rarely involved. Co-infections of cardiotropic viruses are rarely reported and the mechanisms of viral interactions remain unknown. A 5-year old girl had a flu-like syndrome, when she suddenly presented with a respiratory distress and cardiac arrest. At autopsy, the lungs were found haemorrhagic. Lungs’ histology showed severe bronchiolitis, diffuse haemorrhagic necrosis, and mononuclear inflammation. In the heart, a moderate inflammation was found with no necrosis. IAV/H1N1 was detected in nasal and tracheal swabs, lungs, and the heart. The viral load was high in the lungs, but low in the heart. PVB19 was detected in the heart with a high viral load. Viral co-infection increases the risk of severe outcome but the mechanisms of interaction between viruses are poorly understood. In our case, viral loads suggested a reactivated PVB19-induced acute myocarditis during an IAV/H1N1 pneumonia. Viral interactions may involve an IAV/H1N1-induced cytokine storm, with a fulminant fatal outcome. Clinically, our case shows the importance of investigating inflammatory pathways as therapeutic targets.

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Section: Discussionsupporting

confidence: 68%

Coinfection of Parvovirus B19 with Influenza A/H1N1 Causes Fulminant Myocarditis and Pneumonia. An Autopsy Case Report

et al. 2021

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“…There may be possibility of reactivation of Parvovirus B 19 during COVID-19 infection. Immunosuppression or modulation are known to be the main factors of PVB19 reactivation" [9,10].…”

Section: Discussionmentioning

confidence: 99%

Two Swords in the Storm: Parvovirus B19 and COVID-19 Clash in a Myocardial Mayhem of Arrhythmias

Khalikh,

Munde

2023

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Myocarditis can be caused by a variety of infectious and non-infectious illnesses [1]. Although viral infection remains the most commonly identified cause of myocarditis, the role of parvovirus B19 (B19V) from the Erythrovirus genus in the pathogenesis of myocarditis has been identified as a potentially important contributor to myocarditis because of the high prevalence of Parvovirus B 19 (B19V) DNA in hearts of patients with myocarditis [2]. Co-infections of cardiotropic viruses are rarely reported and the mechanisms of viral interactions remain unknown [3]. In this report, we present a case of acute myocarditis in a young male, precipitated by a co-infection of Parvovirus B19 and COVID-19, characterized by fulminant progression and the development of multiple arrhythmias.

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“…The virus has the ability to stay within a cellular reservoir, resulting in relapsing and remitting bouts of a B19 infection [3,4,6,7]. This can be combated by the use of intravenous administration of IgG antibodies against the B19 viral capsid [5][6][7]. It is increasingly important for patients with HIV to be persistently monitored for persistent B19 infection.…”

Section: Discussionmentioning

confidence: 99%

“…An infection with B19 generally self-resolves with the production of specific antibodies that reduce viral action on erythroid progenitor cells by binding to the viral capsid [ 4 ]. As the adaptive immune system creates more IgM antibodies against B19, viremia declines and the subsequent destruction of erythroid progenitor cells declines accordingly [ 5 ]. B19-specific IgM and IgG antibodies are generally produced between two and three weeks, respectively, after primary B19 infection, and these antibodies are responsible for the elimination of B19 [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Parvovirus Infection Leading to Severe Anemia in an Adult Patient With HIV Disease

Tun¹,

Chowdhury²,

Nway³

et al. 2022

Cureus

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Individuals with human immunodeficiency virus (HIV) disease frequently suffer from anemia. The causes include anemia of chronic disease, vitamin B12 and iron deficiency, opportunistic infections (Mycobacterium tuberculosis, Pneumocystis jiroveci), HIV-related bone marrow suppression, AIDS-associated malignancies, and antiretroviral therapy (ART), specifically zidovudine. In HIV patients with advanced immunodeficiency, failure to produce neutralizing antibodies can lead to chronic parvovirus B19 (B19) infection. Normally, in persons with intact immunity, the progression of B19 is self-limited. However, in chronic B19 infection, it can lead to pure red cell aplasia (PRCA) and chronic anemia. In human immunodeficiency virus (HIV)-infected patients, B19-related anemia is rare and underdiagnosed. It has a great response to intravenous immunoglobulin (IVIG) therapy. Hence, early diagnosis and prompt treatment can significantly reduce mortality. In this article, we described the case of a 25-year-old male with HIV infection who presented with a headache. He had severe normocytic anemia with a low reticulocyte count. The workup for blood loss, hemolysis, hemoglobinopathy, and iron deficiency was negative. Because of extremely low reticulocytopenia with severe anemia, the investigations favored multiple myeloma, parvovirus infection, and bone marrow aspiration biopsy. He was tested for parvovirus B19 deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) test due to insufficient seroconversion. It turned out to be positive and he was treated with IVIG therapy.

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A Rare Case of Parvovirus B19 Infection Manifesting as Chronic Aplastic Anemia and Neutropenia in a Human Immunodeficiency Virus-Infected Patient

Cited by 5 publications

References 7 publications

Coinfection of Parvovirus B19 with Influenza A/H1N1 Causes Fulminant Myocarditis and Pneumonia. An Autopsy Case Report

Coinfection of Parvovirus B19 with Influenza A/H1N1 Causes Fulminant Myocarditis and Pneumonia. An Autopsy Case Report

Two Swords in the Storm: Parvovirus B19 and COVID-19 Clash in a Myocardial Mayhem of Arrhythmias

Parvovirus Infection Leading to Severe Anemia in an Adult Patient With HIV Disease

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