Human Parvovirus Infection and Pure Red cell Aplasia in an AIDS Patient: A Case Report
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Abstract
Although anemiais the very common presentation in AIDS patients but the pure red cell aplasia (PRCA), the normocytic normochromic anemia due to the decreased production of only the erythroid progenitor cells, has been rarely mentioned. Herein, onecase of PRCA is recognized in an AIDS patient who also has the evidence of human parvovirus infection. He was a 25-year-old Thai patient who was referred to the hematologist because of the progressive anemia and weight loss. Except for severe anemia, he had no hepatosplenomegaly, no other abnormality on the physical examination. His blood tests were: Hb 3.6 g%, MCV 65.6 fL, MCH 22.7 pg, WBC 4,800/mm3, platelet 216,000/mm3, CD4 count 4/mm3, reticulocyte 0.9%, serum ferritin 1,738.0 ng/mL. The bone marrow study showed the markedly decreased erythroid series despite normocellularity. The PCR for human parvovirus (HPV), HIV Ag/Aband VDRL werefound positive. The HIV viral load was less than 20 copies/ml. Therefore, he was diagnosed as having PRCA, HPV infection, full blown AIDS and late latent syphilis, and treated with ARV regimen containing nevirapine, lamivudine and stavudine, prednisolone 60 mg a day and benzathine penicillin. His Hb concentration as well as MCV was gradually raised to be normal within 2 yearswhereas prednisolone was tapered. Besides anemia of chronic infection, PRCA should be excluded in any HIV-infected patient who had severe normochromic normocytic anemia because it needed some specific therapy such as prednisolone.
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References
Meidani M, Rezaei F, Reza Maracy M, Avijgan M, Tayeri K. Prevalence, severity, and related factors of anemia in HIV/AIDS patients. J Res Med Sci 2012; 17: 138-42.
Levine AM, Berhane K, Masri-Lavine L, Sanchez M, Young M, Augenbraun M, et al. Prevalence and corre-lates of anemia in a large cohort of HIV-infected women: Women’s interagency HIV study. J Acquir Immune DeficSyndr 2001; 26: 28-35.
Volberding PA, Levine AM, Dieterich D, Mildvan D, Mitsuyasu R, Saag M. Anemia in HIV infection: Clinical impact and evidence-based management strategies. Clin Infect Dis 2004; 38: 1454-63.
John MA, Rhemtula YA, Menezes CN, Grobusch MP. Lamivudine-induced red cell aplasia. J Med Microbiol 2008; 57 (Pt 8): 1032-5.
Soma P, Ellemdin S, Mashoeshoe KS. The differential diagnosis of HIV-related anaemia should include pure red cell aplasia. HIV & AIDS Review 2013; 12: 106-7.
Crabol Y, Terrier B, Rozenberg F, Pestre V, Legendre C, Hermine O, et al. Intravenous immunoglobulin the-rapy for PRCA related to human parvovirus B19 infection: a retrospective study of 10 patients and review of the literature. Clin Infect Dis 2013; 56: 968-77.
Sawada K, Hirokawa M, Fujishima N. Diagnosis and management of acquired pure red cell aplasia. Hematol Oncol Clin North Am 2009; 23: 249-59.
สุพรรณ ฟู่เจริญ. ภาวะโลหิตจางธาลั สซีเมียและ ฮีโมโกลบินผิ ดปกติในภาคอีสาน ลาวและเวี ยตนาม. Srinagarind Med J 2013; 25 (suppl): 153-7.
Balakrishnan A, Valsalan R, Sheshadri S, Pandit VR, Medep V, Kumar Agrawal R. Zidovudine-induced pure red cell aplasia. Ind J Pharmacol 2010; 42: 189-91.
Koduri PR, Kumapley R, Valladares J, Teter C. Chronic PRCA caused by parvovirus B19 in AIDS: use of intravenous immunoglobulin-a report of 8 patients. Am J Hematol 1999; 61: 16-20.
Servey JT, Reamy BV, Hodge J. Clinical presentations of parvovirus B19 infection. AmFam Physician 2007; 75: 373-6.
Chernak E, Dubin G, Henry D, Naides SJ, Hodinka RL, Mac Gregor RR. Infection due to parvovirus B19 in patients infected with human immunodeficiency viru. Clin Infect Dis 1995; 20:170-3.
Buchacz K, Patel P, Taylor M, Kerndt PR, Byers RH, Holmberg SD, et al. Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections. AIDS 2004; 18: 2075-9.
Frickhofen N, Chen ZJ, Young NS, Cohen BJ, Heimpel H, Abkowitz JL. Parvovirus B19 as a cause of acquired chronic pure red cell aplasia. Br J Haematol 1994; 87: 818-24.
Kurtzman G, Frickhofen N, Kimball J, Jenkins DW, Nienhuis AW, Young NS. Pure red cell aplasia of 10 years’ duration due to persistent parvovirus B19 infection and its cure with immunoglobulin therapy. NEJM 1989; 321: 519-23.
Jordan JA. Clinical manifestations and pathogenesis of human parvovirus B19 infection. In: UpToDate, Basow DS (Ed), UpToDate, Waltham MA, 2008.
Kondo H, Mori A, Watanabe J, Takahashi Y, Iwasaki H. Purered cell aplasia associated with parvovirus B19 infection in T-large granular lymphocyte leukemia. Leuk Lymphoma 2001; 42: 1439-43.
Kaku Y, Kodama S, Higuchi M, Nakamura M, Kaieda T, Takahama S, et al. Corticoidtherapy for overlapping syndromes in an HIV-positive patient. Intern Med 2015; 54: 223-30.
Pornprasert S, Sonboon P, Kiatwattanacharoen S, Klinbuayaem V, Leenasirimakul P, Promping C, et al. Evolution of hematological parameters in HIV-1-infected patients with and without thalassemia carriages during highly active antiretroviral therapy.
HIV Clin Trials 2009; 10: 88-93.