Human Parvovirus B19 Induced Pure Red Cell Aplasia in a Known Case of Hereditary Spherocytosis; A Bone Marrow Diagnosis

Abstract

Human Parvovirus B19 (HPV B19) is a single stranded DNA virus belonging to parvoviridae family causing an acute self-limiting viral infection transmitted through respiratory droplets. However, in patients with hemolytic anemia, it can cause pure red cell aplasia and eventually aplastic crisis. We report a case of 27-year-old male, who presented with complaints of fever, nausea and body ache for 15 days. Physical examination showed pallor, icterus and splenomegaly. Complete blood count (CBC) revealed pancytopenia. Plasmodium Vivax infection was seen on peripheral blood smear (PBS) and hence was treated with antimalarials, however fever persisted. Bone marrow examination done in view of panytopenia revealed large proerythroblast with eosinophilic intranuclear inclusions.  The impression given was hypercellular marrow with erythroblastopenia with parvoviral inclusions. Parvovirus B19 quantitative PCR showed elevated titers. He is also a diagnosed case of Hereditary Spherocytosis and Gilberts syndrome since 2015. Acute onset pancytopenia in individuals suffering from chronic hemolytic anemias should raise a suspicion of viral infection. Timely diagnosis and supportive management is vital.