Dose‐by‐dose virological and hematological responses to intravenous immunoglobulin in an immunocompromised patient with persistent parvovirus B19 infection

Abstract

A 42-year-old male with stage IV mantle cell lymphoma received chemotherapy and autologous peripheral blood stem cell transplantation. He developed pancytopaenia, and bone marrow examination indicated a parvovirus B19 (PVB 19)-induced red cell aplasia, confirmed by virological tests. Multiple doses of intravenous immunoglobulin (IVIG) were given over the following months, with blood samples being taken after each dose for quantitative PVB 19 DNA and hematological testing to assess the response. Each dose of IVIG produced a 1-3 log(10) drop in PVB 19 DNA levels. Eventually, after the fifth dose of IVIG, the PVB 19 DNA was reduced to <10 copies/ml serum, with a gradual improvement in his hematological parameters. This report demonstrates how close monitoring of the virological and hematological response to IVIG therapy for persistent PVB 19 infection in an immunocompromised patient can optimize the usage of this relatively expensive, and sometimes scarce intervention.

Identification and characterization of acute infection with parvovirus B19 genotype 2 in immunocompromised patients in Poland

“…Similar observations have been reported previously [Lefrère et al, 2005;Liefeldt et al, 2005;Dobec et al, 2007;Tang et al, 2007;Wą sak-Szulkowska et al, 2008] and the probable causes of such infections have been reviewed by . In the case of kidney graft recipient infected with genotype 2 B19V it seems that lack of viral clearance was mainly connected with immunosuppressive therapy impairing the humoral immune response.…”

Viral infections in paediatric patients receiving conventional cancer chemotherapy

“…One should be aware that acute viral myocarditis or even a sustained anaemic period after primary B19 infection could trigger the clinical manifestation of a latent chemotherapy induced cardiomyopathy. Paediatric cancer patients with severe symptoms attributable to B19 infection should be treated with standard immunoglobulins106 107; with real time quantitative PCR based techniques the response of the B19 viraemia can be quantified dose by dose 108…”

“Viral” myocarditis in a patient following allogenic stem cell transplant: Diagnostic dilemma and management considerations

“…16 There are no randomised control trials regarding use of HNIG for treatment of parvovirus infection and most of the evidence for its efficacy is derived from case reports, with some cases demonstrating dose dependent virological and haematological response to treatment. 17 In a systematic review for the treatment regimen (immunoglobulin therapy with or without reduction of immunosuppression) of parvovirus infection in renal transplant recipients, Liefeldt et al reported that although clinical response was noted in majority of reports, virological response was either not found or not determined in a large number of studies. 18 The present case illustrates unusual presentations of infections with common pathogens can occur in immunocompromised patients.…”