A Case of Recurrent Pancytopenia due to Parvovirus B19 Infection in a Renal Transplant Recipient

Pure red cell aplasia due to parvovirus B19 infection after renal transplantation has been rarely reported, and few have been described about pancytopenia due to parvovirus B19. We report a case of recurrent pancytopenia due to parvovirus B19 infection in a renal transplant recipient. Ten days after transplantation, the patient developed severe pancytopenia (WBC 400/mm3, platelet 29,000/mm3, hemoglobin 6.8 g/dL) and his blood sample was positive for parvovirus B19 DNA PCR. Two weeks after 5-day administration of IVIG 400 mg/kg/day, pancytopenia resolved and tacrolimus was converted to cyclosporine A for reducing immunosuppressant potency. However, recurrent pancytopenia developed two months after IVIG treatment. Both blood and bone marrow samples were positive again for parvovirus B19 DNA PCR. Although pancytopenia persisted after another 5-day administration of IVIG 400 mg/ kg/day, excellent hematological response has been achieved with single dose of IVIG 1 g/kg/day. Our case suggested that parvovirus B19 infection should be considered in renal transplant recipients with unexplained severe pancytopenia. High dose IVIG would be an effective therapeutic option, if the infection is recurrent or refractory to the usual dose of IVIG.