Nakamura Yuya, Ohsawa Isao, Goto Yoshikazu, Namba Hokuto, Dodo Yusuke, Tsuji Mayumi, Kiuchi Yuji, Inagaki Masahiro, Gotoh Hiromichi
Department of Internal Medicine, Saiyu Soka Hospital, Japan.
Department of Pharmacology, School of Medicine, Showa University, Japan.
Intern Med. 2018 Feb 1;57(3):403-407. doi: 10.2169/internalmedicine.8809-17. Epub 2017 Nov 1.
A 35-year-old woman with fever, edema and rash was admitted. Pleural effusion and cardiomegaly were observed. A laboratory analysis revealed anemia with iron deficiency and elevated human parvovirus B19 (B19V) immunoglobulin M. The patient's hepcidin-25 and erythroferrone levels were not elevated compared to those observed later in her clinical course. On the other hand, her growth differentiation factor-15 (GDF-15) levels were elevated. She was diagnosed to have heart failure symptoms and anemia with specific iron metabolism abnormalities due to a B19V infection. After providing supportive treatment, the heart failure symptoms disappeared and her anemia had improved. This case emphasizes the need to include a B19V infection in the differential diagnosis when we encounter cases demonstrating reversible heart failure with anemia.
一名35岁发热、水肿及皮疹的女性入院。观察到胸腔积液和心脏扩大。实验室分析显示缺铁性贫血及人细小病毒B19（B19V）免疫球蛋白M升高。与患者临床病程后期观察到的情况相比，其铁调素-25和红细胞生成素水平未升高。另一方面，她的生长分化因子-15（GDF-15）水平升高。她被诊断为因B19V感染导致心力衰竭症状及伴有特定铁代谢异常的贫血。给予支持治疗后，心力衰竭症状消失，贫血有所改善。该病例强调，当遇到表现为可逆性心力衰竭伴贫血的病例时，鉴别诊断中需要考虑B19V感染。
