Pure Red Cell Aplasia and Antibody-Mediated Rejection: Double Trouble in 1 Kidney Transplant Recipient Solved by Intravenous Immunoglobulin Infusion: A Case Report

Transplant Proc. 2020 Oct;52(8):2530-2532. doi: 10.1016/j.transproceed.2020.01.091. Epub 2020 Apr 8.

Abstract

Acquired pure red cell aplasia (PRCA) is characterized by severe normocytic (rarely macrocytic) and normochromic anemia, a low reticulocytes count in peripheral blood, and near absence of erythroid precursors in the bone marrow, with a normal level of erythropoietin. We describe a case of the kidney transplant recipient, diagnosed with PRCA induced with parvovirus B19 infection. Our case demonstrates that although this complication is rare, it should be considered in a differential diagnosis of anemia diagnostics in immunocompromised patients. In our case reduced immune response resulted from post-transplant immunosuppressive therapy. In our patient, apart from infection by parvovirus B19, graft dysfunction due to polyomavirus BK virus infection was also detected together with histologic and serologic features of antibody-mediated renal graft rejection. Considering the entire clinical picture, intravenous immunoglobulin therapy (IVIg) was successfully introduced.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Viral / immunology
  • Erythema Infectiosum / immunology
  • Erythema Infectiosum / virology
  • Erythropoietin
  • Female
  • Graft Rejection / drug therapy
  • Graft Rejection / immunology*
  • Graft Rejection / virology
  • Humans
  • Immunocompromised Host / immunology*
  • Immunoglobulins, Intravenous / administration & dosage
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Parvovirus B19, Human / immunology
  • Postoperative Complications / drug therapy
  • Postoperative Complications / immunology*
  • Postoperative Complications / virology
  • Red-Cell Aplasia, Pure / drug therapy
  • Red-Cell Aplasia, Pure / immunology*
  • Red-Cell Aplasia, Pure / virology*

Substances

  • Antibodies, Viral
  • EPO protein, human
  • Immunoglobulins, Intravenous
  • Erythropoietin