Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2021; 9(8): 1968-1975
Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1968
Human parvovirus B19-associated early postoperative acquired pure red cell aplasia in simultaneous pancreas-kidney transplantation: A case report
Hui Wang, Ying-Xin Fu, Wen-Li Song, Zhen Wang, Gang Feng, Jie Zhao, Ye-Qi Nian, Yu Cao
Hui Wang, Ying-Xin Fu, Wen-Li Song, Zhen Wang, Gang Feng, Jie Zhao, Ye-Qi Nian, Yu Cao, Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
Author contributions: Wang H summarized the clinical data, and drafted the manuscript; Fu YX contributed to the conception of the study; Song WL, Wang Z, Feng G and Zhao J performed the transplant surgery; Nian YQ and Cao Y summarized the clinical data and analyzed the data.
Supported by National Natural Science Foundation of , No. 81970654.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Xin Fu, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. fuyingxintj@163.com
Received: November 5, 2020
Peer-review started: November 5, 2020
First decision: December 24, 2020
Revised: December 30, 2020
Accepted: January 22, 2021
Article in press: January 22, 2021
Published online: March 16, 2021
Processing time: 120 Days and 3.6 Hours
Abstract
BACKGROUND

Acquired pure red cell aplasia (aPRCA) related to human parvovirus B19 (HPV B19) is rarely reported in simultaneous pancreas-kidney transplantation (SPKT) recipients; there has yet to be a case report of early postoperative infection. In this current study, we report the case of a Chinese patient who experienced the disease in the early postoperative period.

CASE SUMMARY

A 63-year-old man, with type 2 diabetes and end-stage renal disease, received a brain dead donor-derived SPKT. Immunosuppression treatment consisted of tacrolimus, prednisone, enteric-coated mycophenolate sodium (EC-MPS), and thymoglobulin combined with methylprednisolone as induction. The hemoglobin (Hb) level declined due to melena at postoperative day (POD) 3, erythropoietin-resistant anemia persisted, and reticulocytopenia was diagnosed at POD 20. The bone marrow aspirate showed decreased erythropoiesis and the presence of giant pronormoblasts at POD 43. Metagenomic next-generation sequencing (mNGS) of a blood sample identified HPV B19 infection at POD 66. EC-MPS was withdrawn; three cycles of intravenous immunoglobulin (IVIG) infusion therapy were administered; and tacrolimus was switched to cyclosporine. The HPV B19-associated aPRCA resolved completely and did not relapse within the 1-year follow-up period. The diminution in mNGS reads was correlated with Hb and reticulocyte count improvements.

CONCLUSION

HPV B19-associated aPRCA can occur at an early period after SPKT. An effective therapy regimen includes IVIG infusion and adjustment of the immuno-suppressive regimen. Moreover, mNGS can be used for the diagnosis and to reflect disease progression.

Keywords: Anemia; Human parvovirus B19; Intravenous immunoglobulin; Metagenomic; Next-generation sequencing; Pancreas transplantation; Case report

Core Tip: This study presents a patient who developed human parvovirus (HPV) B19-associated acquired pure red cell aplasia (aPRCA) in the early postoperative period following simultaneous pancreas-kidney transplantation. Metagenomic next-generation sequencing (mNGS) was used to diagnose HPV B19 infection and the diminution in mNGS reads was correlated with hemoglobin and reticulocyte count improvements. Effective therapy included intravenous immunoglobulin infusion and adjustment of the immunosuppressive regimen. HPV B19-associated aPRCA should be considered when a patient experiences erythropoietin-resistant anemia and reticulocytopenia in the early postoperative period. Moreover, mNGS could be used for diagnosis and to reflect disease progression.