Bhattarai AM, Dhakal B, Rokaya P, Karki A, Gurung S, Baral S. Aplastic anemia induced by human parvovirus B19 infection in an immunocompetent adult male without prior hematological disorders: A case report.
Ann Med Surg (Lond) 2022;
79:103998. [PMID:
35860154 PMCID:
PMC9289335 DOI:
10.1016/j.amsu.2022.103998]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance
Parvovirus B19 (B19V) is a human pathogenic virus of clinical relevance. Human parvovirus B19 infection can be asymptomatic or frequently associated with erythema infectiosum, or joint symptoms in healthy adults. Aplastic anemia as a complication of human parvovirus infection is rare in healthy adults without prior hematological disorders.
Case presentation
We report a case of severe aplastic anemia in a 22-years-old immunocompetent adult male without any hematological dysfunction who presented with periumbilical pain, loose watery stools, and fever with chills and rigor. General examination, laboratory investigation, and peripheral blood smear revealed anemia with leucopenia and relative lymphocytosis, thrombocytopenia, and severe neutropenia. Bone marrow biopsy revealed hypocellular bone marrow with maturation arrest at the proerythroblast stage with intranuclear inclusions and no blast and hematopoietic cells replaced by mature adipocytes in marrow spaces. Parvovirus B19 infection was confirmed by viral serology and polymerase chain reaction.
Clinical discussion
Asymptomatic or mild infection occurs most often when B19 affects immunocompetent adults. However, this is the fourth case reporting severe aplastic anemia in immunocompetent adults and the first case reported in immunocompetent adult males. The patient was admitted for close monitoring and supportive management, which effectively improved the patient's clinical condition, and discharged with a strict follow-up schedule in an outpatient setting.
Conclusion
Thus, acute infection with this virus must be considered a cause of acquired aplastic anemia even in individuals without underlying disease.
Erythema infectiosum, often known as the fifth disease is the most common manifestation in children, whereas, in healthy adults, most cases of infection are asymptomatic or associated with arthritis and myalgia.
•The virus causes infections worldwide that vary in severity depending on the age as well as the immunologic and hematologic status of the host.
•Parvovirus infection should be considered as one of the causes of sudden and severe aplastic anemia even in previously hematologically normal individuals with intact immunity.
•Patients should be treated symptomatically until their hematopoiesis restores, and regular follow-up is critical for detecting chronic anemia or recurrence and treating it promptly.
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