losartan-potassium and Erythema-Infectiosum

Acquired pure red cell aplasia (PRCA) is characterized by severe normocytic (rarely macrocytic) and normochromic anemia, a low reticulocytes count in peripheral blood, and near absence of erythroid precursors in the bone marrow, with a normal level of erythropoietin. We describe a case of the kidney transplant recipient, diagnosed with PRCA induced with parvovirus B19 infection. Our case demonstrates that although this complication is rare, it should be considered in a differential diagnosis of anemia diagnostics in immunocompromised patients. In our case reduced immune response resulted from post-transplant immunosuppressive therapy. In our patient, apart from infection by parvovirus B19, graft dysfunction due to polyomavirus BK virus infection was also detected together with histologic and serologic features of antibody-mediated renal graft rejection. Considering the entire clinical picture, intravenous immunoglobulin therapy (IVIg) was successfully introduced.

Topics: Antibodies, Viral; Erythema Infectiosum; Erythropoietin; Female; Graft Rejection; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Kidney Transplantation; Male; Middle Aged; Parvovirus B19, Human; Postoperative Complications; Red-Cell Aplasia, Pure

Topics: Adolescent; Blood Transfusion; Drug Resistance; Erythema Infectiosum; Erythropoietin; Hematinics; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Nephritis, Hereditary; Opportunistic Infections; Red-Cell Aplasia, Pure; Treatment Outcome

Approximately 10% of patients receiving recombinant human erythropoietin (rHuEPO) do not respond to the treatment. We evaluated parvovirus B19 (B19) and cytomegalovirus (CMV) infections and antierythropoietin (anti-EPO) antibodies as potential causes of anemia in dialyzed patients, hyporesponsive to rHuEPO.. Data from 120 dialyzed patients, receiving rHuEPO alfa, were collected: demographic characteristics, rHuEPO dose, duration of rHuEPO treatment and time on dialysis, etiology of chronic kidney disease and transfusion history. Serology and PCR were performed to address B19 and CMV infection status. An ELISA was developed to detect anti-EPO antibodies.. rHuEPO resistance correlated with high ferritin levels (p = 0.001) and short time on dialysis (p = 0.012). B19 DNA was found in 10 (8.3%) dialyzed patients and CMV DNA was detected in 33 (27.5%). There was no significant correlation between B19 infection and anemia,while a tendency of correlation between active CMV infection and hemoglobin levels or hematocrit value (p= 0.069 and p= 0.070, respectively) has been observed. Anti-EPO antibodies were not detected in any patient.. B19 infection is a rare complication in dialyzed patients and should be investigated after exclusion of other common causes, while CMV infection is rather common. The role of CMV infection in the hyporesponsiveness in dialyzed patients should be further evaluated in other studies. Our data suggest that anti-EPO antibodies are not involved in rHuEPO resistance in this population.

Topics: Adult; Aged; Antibodies, Neutralizing; Antiviral Agents; Case-Control Studies; Cytomegalovirus Infections; Drug Resistance, Viral; Epoetin Alfa; Erythema Infectiosum; Erythropoietin; Female; Humans; Male; Middle Aged; Parvovirus B19, Human; Recombinant Proteins; Red-Cell Aplasia, Pure; Renal Dialysis