Successful Treatment of Posttransplant Refractory Pure Red Cell Aplasia Following Parvovirus B19 Infection

Pure red cell aplasia (PRCA), a rare cause of anemia limited to the erythroid lineage, is characterized by normocytic normochromic anemia, severe reticulocytopenia, and markedly reduced or absent erythroid precursors in the bone marrow. We report a 44-year-old male with end-stage renal disease (ESRD) secondary to autosomal dominant polycystic kidney disease (ADPKD) who developed refractory PRCA following a live-donor renal transplant. One month posttransplant, the patient presented with severe, persistent anemia accompanied by fatigue and dyspnea. Initial management included blood transfusions, vitamin B12 supplementation, and adjustments to immunosuppressive therapy due to suspected drug-induced cytopenia. Bone marrow biopsy confirmed PRCA, and polymerase chain reaction (PCR) revealed a persistently elevated parvovirus B19 infection, a commonly recognized etiology of PRCA in immunocompromised patients. Treatment included intravenous immunoglobulin (IVIG) and frequent blood transfusions. Despite therapy, the patient experienced recurrent anemia, pancytopenia, and febrile neutropenia. Over successive hospitalizations, hematologic improvement was achieved with hemoglobin stabilization and significant viral load reduction. This case underscores the diagnostic and therapeutic complexity of managing parvovirus B19-induced PRCA in posttransplant patients, emphasizing the need for individualized strategies incorporating IVIG, supportive care, and tailored immunosuppressive regimens.