Parvovirus B19 is a nonenveloped
single-stranded DNA virus that commonly causes a benign childhood
infection typically manifesting as a "slapped-cheek"
rash. In immunodeficient hosts, this
infection can cause persistent
anemia and occasionally
pancytopenia. Recently, direct renal involvement has been reported in renal transplant recipients leading to various forms of glomerulopathy and allograft dysfunction. Most cases are primary
infections and are donor transmitted through the transplanted organ. Clinical and virological response to
intravenous immunoglobulin (Ig) is usually excellent. We describe a case of donor-transmitted
parvovirus infection in a 23-year-old male who received his first cadaver renal transplant. The patient had an uncomplicated postoperative course with immediate graft function. Eight weeks after
transplantation, he presented with
fever,
polyarthralgia,
pancytopenia, and allograft dysfunction. Serological studies revealed elevated
IgM titers against parvovirus B19. A renal biopsy was performed, which showed no evidence of acute rejection but with moderate degree of tubular damage. Parvovirus B19
viral DNA was detected in the renal tissue via polymerase chain reaction (PCR). The patient received a 10-day course of
intravenous Ig (400 mg/kg/day) with excellent response. His blood count normalized and the allograft improved to baseline function. The incidence of
parvovirus infection in renal transplant patients is probably underestimated, because patients are not routinely screened for it and
anemia and/or
pancytopenia in these patients are often ascribed to immunosuppressive drugs. Because this
infection is treatable, we conclude that
parvovirus B19 infection should be actively considered in transplant patients presenting with
pancytopenia and allograft dysfunction.