Bhattarai Ayush Mohan, Dhakal Bishal, Rokaya Pooja, Karki Abinash, Gurung Shekhar, Baral Smarika
Shree Birendra Hospital, Kathmandu, Nepal.
Nepalese Army Institute of Health Sciences, Kathmandu, Nepal.
Ann Med Surg (Lond). 2022 Jun 15;79:103998. doi: 10.1016/j.amsu.2022.103998. eCollection 2022 Jul.
Parvovirus B19 (B19V) is a human pathogenic virus of clinical relevance. Human parvovirus B19 infection can be asymptomatic or frequently associated with erythema infectiosum, or joint symptoms in healthy adults. Aplastic anemia as a complication of human parvovirus infection is rare in healthy adults without prior hematological disorders.
We report a case of severe aplastic anemia in a 22-years-old immunocompetent adult male without any hematological dysfunction who presented with periumbilical pain, loose watery stools, and fever with chills and rigor. General examination, laboratory investigation, and peripheral blood smear revealed anemia with leucopenia and relative lymphocytosis, thrombocytopenia, and severe neutropenia. Bone marrow biopsy revealed hypocellular bone marrow with maturation arrest at the proerythroblast stage with intranuclear inclusions and no blast and hematopoietic cells replaced by mature adipocytes in marrow spaces. Parvovirus B19 infection was confirmed by viral serology and polymerase chain reaction.
Asymptomatic or mild infection occurs most often when B19 affects immunocompetent adults. However, this is the fourth case reporting severe aplastic anemia in immunocompetent adults and the first case reported in immunocompetent adult males. The patient was admitted for close monitoring and supportive management, which effectively improved the patient's clinical condition, and discharged with a strict follow-up schedule in an outpatient setting.
Thus, acute infection with this virus must be considered a cause of acquired aplastic anemia even in individuals without underlying disease.
细小病毒B19（B19V）是一种具有临床相关性的人类致病病毒。人类细小病毒B19感染可能无症状，或常与传染性红斑、健康成年人的关节症状相关。作为人类细小病毒感染并发症的再生障碍性贫血在无既往血液系统疾病的健康成年人中罕见。
我们报告一例22岁免疫功能正常的成年男性发生严重再生障碍性贫血的病例，该患者无任何血液系统功能障碍，表现为脐周疼痛、稀水样便、伴有寒战和高热的发热。全身检查、实验室检查及外周血涂片显示贫血伴白细胞减少和相对淋巴细胞增多、血小板减少及严重中性粒细胞减少。骨髓活检显示骨髓细胞减少，早幼红细胞阶段成熟停滞，有核内包涵体，无原始细胞，骨髓间隙中造血细胞被成熟脂肪细胞替代。通过病毒血清学和聚合酶链反应确诊为细小病毒B19感染。
B19感染免疫功能正常的成年人时，最常发生无症状或轻度感染。然而，这是第四例报告免疫功能正常的成年人发生严重再生障碍性贫血的病例，也是首例报告免疫功能正常的成年男性发生该病的病例。患者入院接受密切监测和支持治疗，有效改善了临床状况，并在门诊严格随访安排下出院。
因此，即使在无基础疾病的个体中，也必须考虑这种病毒的急性感染是获得性再生障碍性贫血的病因。
