Parvovirus B19 induced acute severe anaemia in a well-controlled HIV-positive individual

Background

We describe the unusual case of a parvovirus B19 (PB19) infection inducing a severe acute aplastic anaemia with secondary multiorgan dysfunction in the context of well-controlled HIV and the absence of an underlying chronic haemolytic disorder. Treatment with intravenous immunoglobulin therapy (IVIG) was also required in this case due to persisting reticulocytopaenia, seemingly at odds with established descriptions of PB19 related anaemic syndromes as either chronic Pure Red Cell Aplasia or acute Transient Aplastic Crises.

Case presentation

A 25-year-old Brazilian male tourist living with well-controlled HIV and undetectable HIV viral load presented in extremis with multiorgan dysfunction after a 5-day history of non-specific illness. Investigation for PB19 confirmed a positive IgM, weakly positive IgG, and significant PB19 viraemia. He received initial supportive management with blood products and was later given two doses of 1 g/kg immunoglobulin therapy for persistent reticulocytopaenia. He was able to be discharged to his country of origin and reported no subsequent relapse at follow up at one year.

Conclusions

Severe PB19 infections remain a rare but significant phenomenon amongst patients living with HIV even in the context of adherence to effective antiretroviral therapy, and it appears hyperacute presentations are possible even without underlying chronic haemolytic disorders. Though there is a dearth of contemporary practice managing these infections, treatment with IVIG remains a cornerstone therapy in these instances where ART alone is not sufficient to resolve reticulocytopaenia.