Diagnostic Challenge of a Rare Cause of Anemia After Kidney Transplant: Seronegative Parvovirus B19 Detected by PCR and Bone Marrow Findings.

Abstract

Objective: Anemia is a common complication in kidney transplant patients, often attributed to viral infections. Our objective was to describe a rare case of severe anemia secondary to Parvovirus B19 infection in a kidney transplant recipient, highlighting diagnostic and therapeutic challenges in the immunosuppressed setting.

Case report: We present a 43-year-old woman with end-stage renal disease secondary to polycystic kidney disease who received a living-kidney transplant from her husband. Seven months after transplantation, she presented with severe anemia, fatigue, and palpitations. Laboratory findings demonstrated severe normocytic, normochromic anemia (Hb: 5.8 g/dL). Parvovirus B19 serology tests were negative twice, while PCR testing revealed a significant viral load (25×10⁶ copies/mL). Bone marrow biopsy findings included giant proerythroblasts with characteristic viral nuclear inclusions. The patient received intravenous immunoglobulin (IVIG, 100 mg/kg/day for 4 days), and mycophenolate mofetil was discontinued. After therapy, hemoglobin levels and viral load improved significantly, leading to successful resolution of anemia.

Conclusion: This case emphasizes the importance of considering Parvovirus B19 in the differential diagnosis of anemia in transplant patients. In immunosuppressed individuals, PCR and bone marrow analysis can be essential for diagnosis, especially when serologic tests are inconclusive. Timely intervention can lead to favorable outcomes.