Furukawa Masanori, Kaji Kosuke, Masuda Hiroyuki, Ozaki Kuniaki, Asada Shohei, Koizumi Aritoshi, Kubo Takuya, Nishimura Norihisa, Sawada Yasuhiko, Takeda Kosuke, Mashitani Tsuyoshi, Kubo Masayuki, Amano Itsuto, Ootani Tomoyuki, Ohbayashi Chiho, Murata Koji, Ann Tatsuichi, Mitoro Akira, Yoshiji Hitoshi
Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
Second Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
Case Reports Hepatol. 2017;2017:1359486. doi: 10.1155/2017/1359486. Epub 2017 Apr 20.
Human parvovirus (HPV) B19 is linked to a variety of clinical manifestations, such as erythema infectiosum, nonimmune hydrops fetalis, and transient aplastic anemia. Although a few cases have shown HPVB19 infection as a possible causative agent for hepatitis-associated aplastic anemia (HAAA) in immunocompetent patients, most reported cases of HAAA following transient hepatitis did not have delayed remission. Here we report a rare case of severe aplastic anemia following acute hepatitis with prolonged jaundice due to HPVB19 infection in a previously healthy young male. Clinical laboratory examination assessed marked liver injury and jaundice as well as peripheral pancytopenia, and bone marrow biopsy revealed severe hypoplasia and fatty replacement. HPVB19 infection was diagnosed by enzyme immunoassay with high titer of anti-HPVB19 immunoglobulin M antibodies. Immunosuppressive therapy was initiated 2 months after the onset of acute hepatitis when liver injury and jaundice were improved. Cyclosporine provided partial remission after 2 months of medication without bone marrow transplantation. Our case suggests that HPVB19 should be considered as a hepatotropic virus and a cause of acquired aplastic anemia, including HAAA.
人细小病毒（HPV）B19与多种临床表现相关，如传染性红斑、非免疫性胎儿水肿和暂时性再生障碍性贫血。尽管有少数病例显示，在免疫功能正常的患者中，HPVB19感染可能是肝炎相关性再生障碍性贫血（HAAA）的病因，但大多数报告的短暂性肝炎后发生HAAA的病例并无延迟缓解情况。在此，我们报告一例罕见病例，一名既往健康的年轻男性因HPVB19感染导致急性肝炎伴长期黄疸后发生严重再生障碍性贫血。临床实验室检查评估显示有明显的肝损伤、黄疸以及外周全血细胞减少，骨髓活检显示严重发育不全和脂肪替代。通过酶免疫测定法诊断为HPVB19感染，抗HPVB19免疫球蛋白M抗体滴度很高。在急性肝炎发病2个月后，当肝损伤和黄疸有所改善时开始免疫抑制治疗。使用环孢素治疗2个月后，在未进行骨髓移植的情况下病情部分缓解。我们的病例表明，HPVB19应被视为一种嗜肝病毒，也是获得性再生障碍性贫血（包括HAAA）的病因。
