Tanaka Yuka, Takahashi Yasuyuki, Kimura Yuta, Tomikawa Tatsuki, Anan Tomoe, Sagawa Morihiko, Tabayashi Takayuki, Watanabe Reiko, Tokuhira Michihide, Momose Shuji, Tamaru Jun-Ichi, Kizaki Masahiro
Department of Hematology, Saitama Medical Center, Saitama Medical University.
Department of Pathology, Saitama Medical Center, Saitama Medical University.
Rinsho Ketsueki. 2018;59(6):682-687. doi: 10.11406/rinketsu.59.682.
Human parvovirus B19 (HPV-B19) causes hemophagocytic lymphohistiocytosis (HLH). Here we describe a 35-year-old female with hereditary spherocytosis (HS) who developed HLH due to HPV-B19 infection. Upon admission, she had high fever and diarrhea. Laboratory findings included severe pancytopenia and elevated serum triglyceride and ferritin levels. Moreover, high HPV-B19 levels in the peripheral blood and increased reactive lymphocytosis in the bone marrow led to a diagnosis of HLH due to HPV-B19 infection. With supportive therapy and a blood transfusion, HLH symptoms, including fever and myelosuppression, improved in 1 week. However, symptoms of heart failure (HF) suddenly developed, and an echocardiography revealed diffuse systolic dysfunction, suggesting viral myocarditis due to HPV-B19 infection. Conservative management with diuretics gradually improved HF symptoms over a period of 2 weeks. HPV-B19 infection in adult patients with HS rarely results in severe HLH, but conservative therapy may improve the symptoms. Nonetheless, a careful follow-up is required after HLH improves because viral myocarditis can develop, as was seen in our patient.
人细小病毒B19（HPV-B19）可引起噬血细胞性淋巴组织细胞增生症（HLH）。在此，我们描述一名35岁患有遗传性球形红细胞增多症（HS）的女性，她因HPV-B19感染而发生HLH。入院时，她有高热和腹泻。实验室检查结果包括严重全血细胞减少以及血清甘油三酯和铁蛋白水平升高。此外，外周血中HPV-B19水平升高以及骨髓中反应性淋巴细胞增多导致诊断为因HPV-B19感染所致的HLH。经过支持治疗和输血，包括发热和骨髓抑制在内的HLH症状在1周内得到改善。然而，心力衰竭（HF）症状突然出现，超声心动图显示弥漫性收缩功能障碍，提示因HPV-B19感染所致的病毒性心肌炎。使用利尿剂的保守治疗在2周内逐渐改善了HF症状。患有HS的成年患者感染HPV-B19很少导致严重HLH，但保守治疗可能改善症状。尽管如此，HLH改善后仍需要仔细随访，因为正如我们的患者那样，可能会发生病毒性心肌炎。
