Chronic parvovirus B19 infection in a pediatric lung transplanted patient

Abstract

In immunocompromised patients, clinical manifestations of human parvovirus B19 (PVB19) infection are mostly reported as acute or chronic hematological disorders. Recently, PVB19 infection has been associated with nonhematological symptoms. Four years after lung transplantation, a 9-year-old girl developed a severe anemia with reticulocytopenia requiring blood transfusion. PVB19 DNA was found by polymerase chain reaction in blood. Blood marrow aspiration revealed typical features of PVB19 infection. She was successfully treated with high dose of i.v. Ig. Then, she exhibited recurrent nonregenerative anemia requiring another course of i.v. Ig. PVB19 DNA has been persisted in blood with no specific immune response. At the same time, she suffered from several lung infection syndromes with no microorganism found except PVB19 DNA. Recurrent mild renal dysfunction was noticed with no other explanation than PVB19 infection. This report indicates that pediatric transplanted patients are at risk of chronic PVB19 infection, which can be associated with lung and/or renal disorders.

Parvovirus B19 Infection after Transplantation: A Review of 98 Cases

“…Intact Aleutian mink disease parvoviral DNA has also been detected in glomeruli [85]. These animal data support the suggestion that PVB19 is a potential cause of pneumonitis [22,31,68], hepatitis [28,58,63,66,86], and collapsing glomerulopathy [26] in humans. Indeed, PVB19 has been demonstrated in the renal tissue and blood of patients with collapsing glomerulopathy and in hepatocytes of a patient with fibrosing cholestatic hepatitis [58].…”

“…Including the 7 cases we described here, the data from a total of 98 patients are summarized in [7, 10, 11, 16, 18, 24, 26, 30-32, 36, 39, 44, 45, 47, 48, 58, 68], skin rash occurred in 13.3% [12,24,28,31,36,39], and arthralgia occurred in 6.0% of patients [18,22,35,38,68]. PVB19-associated anemia was accompanied by organ-invasive manifestations in 11% of patients, including myocarditis (probable cases in 2% of patients; possible cases in 2% of patients) [17,22,28,43,57], pneumonitis (definite cases in 1%; probable cases in 1%; possible cases in 1%) [22,31,68], hepatitis (probable cases in 2%; possible cases in 2%) [28,58,63,66], and collapsing glomerulopathy (probable cases in 1%) [26]. Thrombotic microangiopathy was reported in 4% of patients [54].…”

Parvovirus B19 and the pathogenesis of anaemia

“…With regard to immunosuppressive agents, the immunocompromised patient receiving calcineurin inhibitors such as tacrolimus, a potent inhibitor of IL-2 production, cannot elaborate an effective Th1 immune response and therefore is not able to clear the virus [54]. Thus, tacrolimus has recently been suspected of facilitating persistent B19 infection [55,56].…”

Parvovirus B19 pneumonia in a child undergoing allogeneic hematopoietic stem cell transplantation

“…2 Whereas severe pulmonary complications due to B19 have not been reported in patients undergoing HSCT, pneumonia was diagnosed in a young boy with acute B19 infection after heart transplantation and in a 9-year-old girl with chronic B19 infection after lung transplantation. 4,5 In the heart transplant patient, the diagnosis of acute B19 infection was made on the basis of fever, rash and a high IgM antibody level, and pneumonia was attributed to B19 infection since no other pathogen was detected. 4 The girl with chronic B19 infection after lung transplantation had persisting B19 viremia and suffered from recurrent nonregenerative anemia.…”

“…During one episode of anemia, the girl developed pneumonia, and the B19 genome was detected in the BAL fluid. 5 However, it is important to note that the B19 genome may also be detected in BAL samples in patients after transplantation who do not suffer from pneumonia. 6 In our patient, we detected B19 DNA not only in the BAL fluid, but also in pleural exudate and, most importantly, in lung tissue, which has, to the best of our knowledge, not been reported in immunocompromised patients to date.…”