A Rare Case of Parvovirus B19 Infection Induced Paroxysmal Cold Hemoglobinuria in an Adult Female

Abstract

Paroxysmal cold hemoglobinuria (PCH) is a rare form of autoimmune hemolytic anemia (AIHA). PCH occurs in acute and chronic forms. The main risk factors for PCH include viral infections, vaccination, and syphilis. PCH presentations are common in the pediatric population. The occurrence of PCH following parvovirus B19 infection in adults is rare. We report a case of a 23-year-old female who presented with giddiness, fatigue, greying of vision, and presyncope for four days, on subsequent evaluation was found to have evidence of hemolysis and bone marrow suppression. Parvoviral intranuclear inclusions were detected in bone marrow biopsy and parvoviral B19 IgM antibody was detected. Donath Landsteiner antibody test was also positive. Hence a diagnosis of PCH secondary to parvovirus B19 infection was made. She was started on pulse dose steroids and intravenous immunoglobulin (IVIG) and showed significant improvement.

Successful Treatment of Warm Autoimmune Hemolytic Anemia with a Positive Donath-Landsteiner Test Using Rituximab

“…PCH has historically been associated with syphilis infection. In children, it usually occurs in boys under five years old and has recently been reported in AIHA following viral or bacterial infections, including measles, mumps, varicella, cytomegalovirus, Epstein Barr virus, influenza virus, parvovirus B19, coxsackievirus, and adenovirus, which are transient and do not recur (5). PCH is rare in adults but can be caused by malignant diseases, such as non-Hodgkin lymphoma or chronic lymphocytic leukemia (6,7).…”