Long-term remission of recurrent severe anemia as a result of parvovirus B19 infection in a pediatric renal transplant recipient

Abstract

We studied a case of recurrent PV-B19-associated anemia in a renal transplant child with long-term remission induced by baseline immunosuppression adjusted and intensive IVIG therapy. This was a 15-yr-old boy. Seven wk after transplantation, he experienced acute rejection, which was treated with high-dose steroids, ATG, and plasmapheresis. Ten wk after transplantation (three wk after rejection), his hemoglobin dropped to 54 g/L and serum PV-B19 PCR was positive. After therapy with IVIG and conversion from mycophenolate mofetil to rapamycin, anemia resolved. But the patient had fever on the fourth day of IVIG with mild pulmonary edema and rise in serum creatinine. Two months after the first course of IVIG, anemia recurred and a second course of IVIG (preadministration methylprednisolone) was given, which was followed by the resolution of anemia without side effect and recurrence two months later again. Baseline immunosuppression was adjusted with dual immunosuppression and low doses including prednisolone and tacrolimus. At the same time, monthly course of IVIG was repeated four times. Within the next 23 months, anemia did not recur and renal function remained stable. In conclusion, PV-B19-associated anemia can be recurrent in immunocompromised children and baseline immunosuppression should be carefully adjusted to control PV-B19 infection.