Infección por parvovirus B19 en trasplante renal. Diagnóstico por detección del genoma viral en sangre periférica / Parvovirus B19 infection in a renal transplant recipient. Diagnosis by detection of viral genome in peripheral blood

RESUMEN

El parvovirus B19 puede producir un cuadro de anemia conocido como aplasiapura de células rojas en los receptores de trasplantes de órganos. A veces se asocia adisminución de las otras series sanguíneas y a variada patología extrahematológica. Eldiagnóstico se suele hacer mediante examen de la médula ósea. El valor de la deteccióndel genoma viral en sangre no está bien delimitado. Se describe el caso de unvarón de 17 años que presentó fiebre, anemia recitulocipénica y hepatitis debida ainfección por parvovirus B19, cuyo diagnóstico se realizó mediante determinaciónseriada del genoma viral en sangre periférica y se confirmó por biopsia de cresta iliaca.El paciente respondió al tratamiento con inmunoglobulinas, recuperándose completamentede los síntomas y no presentando recaídas.Se sugiere que ante la presencia de anemia de origen no filiado en un paciente contrasplante renal se debe realizar una PCR de Parvovirus B19 en sangre periférica, sobretodo si se acompaña de reticulocitopenia. La detección del genoma viral en plasma permiterealizar un diagnóstico y tratamiento precoz, evitando la administración de transfusionessanguíneas innecesarias, y posiblemente la realización de una biopsia ósea

ABSTRACT

Parvovirus B19 can produce a picture known as pure red blood aplasia in recipientsof solid organ. Occasionally the viruses cause decrease of the other blood cells, and various extra-hematologic manifestations. Common diagnosis is realised by bonemarrow examination. The diagnostic value of the viral genome in the blood stream isnot well defined.We reported the case of a male of 17 years of age, whose diagnosis was done byrepeated determinations of the viral parvovirus B19 genome in peripheral blood. Itwas confirmed by a biopsy of the iliac crest. The patient was treated with unspecificIgG immunoglobulins, with complete recovery from the symptoms and signs. It didnot have any recurrence of the disease.This case suggests that the realisation of PCR of Parvovirus B19 in renal transplantpatients with pure red cell aplasia could be of greater interest in the diagnosis andmonitoring of the disease. The detection of the viral genome could avoid the administrationof unnecessary blood transfusions, and possibly the realization of bonemarrow biopsyParvovirus B19 can produce a picture known as pure red blood aplasia in recipients of solid organ. Occasionally the viruses cause decrease of the other blood cells, and various extra-hematologic manifestations. Common diagnosis is realised by bone marrow examination. The diagnostic value of the viral genome in the blood stream is not well defined. We reported the case of a male of 17 years of age, whose diagnosis was done by repeated determinations of the viral parvovirus B19 genome in peripheral blood. It was confirmed by a biopsy of the iliac crest. The patient was treated with unspecific IgG immunoglobulins, with complete recovery from the symptoms and signs. It did not have any recurrence of the disease. This case suggests that the realisation of PCR of Parvovirus B19 in renal transplant patients with pure red cell aplasia could be of greater interest in the diagnosis and monitoring of the disease. The detection of the viral genome could avoid the administration of unnecessary blood transfusions, and possibly the realization of bone marrow biopsy