Navkiran Randhawa
Franciscan Health Olympia Fields
Olympia Fields, Illinois
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Title: Transformation of cells: a bizarre presentation of ParvovirusB19 in the immunocompromised
Introduction: Parvovirus B19 (PB19) is a single-stranded DNA virus of the family Parvoviridae that presents with chronic pure red cell aplasia in immunocompromised patients. We present a 73 year old male with a unique presentation of the AML blast crisis with MDS features secondary to acute PB19 infection.
Description: We present a 73 year old Caucasian male with no past medical history who was admitted to our intensive care unit for painless, bright red blood per rectum after straining without any bowel movements. Initial work up was remarkable for non-ST elevation myocardial infarction (NSTEMI) type 1 and pancytopenia with hemoglobin 9.0 g/dL (baseline 14 g/dL), white blood count 3.2, and platelet count 36,000/uL. Cardiology and gastroenterology held off on any intervention and was medically optimized. An autoimmune, anti-inflammatory, coronavirus and HIV tests were negative. Parvovirus B-19 IgM was positive. A bone marrow biopsy to determine the etiology of thrombocytopenia revealed acute myeloid leukemia (AML) with myelodysplastic features with 70% blast cells. Fluorescence in situ hybridization (FISH) showed chromosome 5q (66%) and 7q (~73-74%) deletions, and positive for p53 mutation. He was transferred to a tertiary care center for the AML blast crisis.
Discussion: Parvovirus B19 (PB19) is usually asymptomatic in immunocompetent adults and is self-limiting. PB19 uses erythroid lineage from bone marrow to replicate in immunocompetent humans. However, chronic PB19 infection most commonly causes transient aplastic crisis or pure red cell aplasia in immunocompromised patients. Our patient presented with severe pancytopenia and was diagnosed with acute PB19 infection leading to AML blast crisis with MDS features. He chose to be treated symptomatically with blood and platelet transfusions due to acute ongoing medical conditions. PB19 induced anemia usually resolves within a few days to weeks and supportive transfusion. Intravenous immunoglobulin (IVIG) infusion is recommended for immunosuppressed patients with chronic PB19. However, patients with myelodysplasia do not respond to IVIG. The best way to prevent PB19 is to decrease transmission with good hand hygiene and avoid sick contacts.