Abstract: TH-PO0930
Late-Onset Parvovirus B19 in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Dixit, Shubham, University of California Irvine, Irvine, California, United States
- Tantisattamo, Ekamol, University of California Irvine, Irvine, California, United States
Introduction
Typical manifestations of Parvovirus B19 (B19V) infection occur within the first two months post-transplant including anemia, leukopenia, thrombocytopenia, or graft dysfunction. We report a case of a young female kidney transplant recipient presenting with acute symptomatic anemia and a work-up revealed highly elevated B19V. Anemia responded to lower immunosuppression and intravenous immunoglobulin (IVIG).
Case Description
A 36-year-old woman with end-stage kidney disease secondary to IgA nephropathy underwent an uneventful deceased donor kidney transplantation with maintenance immunosuppressive medications including tacrolimus, azathioprine, and prednisone. Almost one-year post-transplant, she developed subjective fevers, dyspnea on exertion, and fatigue, followed by acute chest pain, prompting emergency evaluation. Vital signs and physical examination were unremarkable. Laboratory testing revealed acute on chronic anemia (hemoglobin from 11.2 to 8.9 g/dL), leukopenia (WBC 2.9 × 10^3/µL), and non-oliguric acute kidney injurywith a baseline creatinine of 0.6–0.8 up to 1.2 mg/dL). The hemolysis work-up was negative. CMV PCR was <30 IU/mL and EBV was undetectable. Chest, abdomen, and pelvic CT scans showed no hepatosplenomegaly, lymphadenopathy, or granulomatous disease. B19V testing returned with a very high viral load of >100000000 IU/mL (Ref. range 0 – 10000000 IU/mL) and positive IgG and IgM serology.
Azathioprine was held and she received IVIG1 g/kg for two doses and packed red blood cells 1 unit for symptomatic anemia (nadir hemoglobin 7.6 g/dL). At discharge, her hemoglobin improved to 9.2 g/dL, though leukopenia persisted (WBC 2.6 × 10^3/µL; nadir 1.6 × 10^3/µL). Two weeks post-discharge, her hemoglobin rose to 10.7 g/dL, and leukopenia resolved. Immune cell function testing demonstrated low responsiveness (33 ATP ng/mL; reference >225). Given sustained symptomatic improvement, azathioprine was resumed, and weekly darbepoetin was initiated for residual anemia.
Discussion
While anemia is one of the common signs of B19V, late onset of B19V is uncommon. The role of routine B19 screening remains unclear given its overlapping presentation with more common opportunistic infections such as CMV and EBV infections. This case highlights that B19V should be considered in transplant patients with unexplained cytopenias and evidence of overimmunosuppression regardless of the period post-transplant.