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Severe multiorgan failure after parvovirus B19 infection in an allogeneic stem cell transplant recipient

Bone Marrow Transplantation volume 34, pages 469–470 (2004)Cite this article

Parvovirus B19 infections occur fairly frequently in children, and the most common clinical picture is erythema infectiosum.1 In patients with an underlying hemolytic disorder, this can cause a transient aplastic crisis. In recipients of allogeneic stem cell transplantation (SCT)2 and in other patients with severe immunodeficiencies,3 the viremia can persist and cause chronic pure red cell aplasia. Here, we describe an allogeneic SCT recipient who developed severe pancytopenia with multiorgan failure (MOF) after parvovirus B19 infection. To our knowledge, this is the first report of this severe complication of parvovirus B19 infection following allogeneic SCT.

Transient aplasia can be associated with parvovirus B19 infection in patients with a high erythrocyte destruction rate, including those with sickle cell disease, thalassemia or hereditary spherocytosis. It can be life threatening without blood transfusions. Most of the otherwise immune-competent patients will recover spontaneously. However, in immune-compromised patients, for example, allogeneic bone marrow transplant recipients or HIV-positive patients,4 parvovirus B19 infection can persist and may cause chronic pure red cell aplasia. The reason for leuko- and thrombocytopenia, which is also sometimes present, is possibly cytotoxicity of the viral nonstructural protein (NS1) and also hemophagocytosis.4, 5 Damage to erythrocyte precursor cells by parvovirus B19 takes place via the blood group P-antigen receptor.1 Recipients of SCT are more likely to acquire parvovirus B19 infection because immune globulin production and T-cell function are very poor during the first year post transplant, the time period of most reported cases of parvovirus B19-induced aplastic crises. Indeed, our patient had a very delayed immune response to the parvovirus infection as the T-cell-dependent switch from IgM to IgG occurred only 1 year after the primary infection. The significance of the high parvovirus load that remained (Table 1) is presently unknown, but is probably also related to the ongoing immunodeficiency.

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  1. Department of Hematology, University Medical Center, Utrecht, The Netherlands

    H-J Klümpen, E J Petersen & L F Verdonck

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  1. H-J Klümpen
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  2. E J Petersen
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  3. L F Verdonck
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Klümpen, HJ., Petersen, E. & Verdonck, L. Severe multiorgan failure after parvovirus B19 infection in an allogeneic stem cell transplant recipient. Bone Marrow Transplant 34, 469–470 (2004). https://doi.org/10.1038/sj.bmt.1704612

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