Postrenal transplant hemophagocytic lymphohistiocytosis and thrombotic microangiopathy associated with parvovirus B19 infection

M. R. Ardalan, Mohammadali Mohajel Shoja, R. S. Tubbs, H. Esmaili, H. Keyvani

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Persistent anemia is a known consequence of Parvovirus B19 (B19) infection following renal transplantation. However, to date, no description of B19-related hemophagocytic lymphohistiocytosis (HLH) exists in renal transplant recipients. We report a 24-year-old male kidney recipient, who presented with fever, severe anemia and allograft dysfunction two years following transplantation. Hyperferritinemia, hypertriglyceridemia, elevated serum lactate dehydrogenase, pancytopenia and fragmented red blood cells on the peripheral blood were also noted. Bone marrow examination revealed giant pronormoblasts and frequent histiocytes with intracellular hematopoietic elements, consistent with HLH. Renal allograft biopsy revealed closure of the lumen of glomerular capillaries and thickening of the capillary walls compatible with thrombotic microangiopathy. The presence of anti-B19 IgM antibody and viral DNA in the patient's serum (detected by real-time PCR) confirmed an acute B19 infection. Following high-dose intravenous immunoglobulin therapy, the anemia gradually resolved and renal function improved. As far as we know, this is the first report of B19-associated HLH and thrombotic microangiopathy in a renal transplant recipient.

Original languageEnglish (US)
Pages (from-to)1340-1344
Number of pages5
JournalAmerican Journal of Transplantation
Volume8
Issue number6
DOIs
StatePublished - Jun 1 2008
Externally publishedYes

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Thrombotic Microangiopathies
Parvoviridae Infections
Hemophagocytic Lymphohistiocytosis
Transplants
Kidney
Anemia
Allografts
Bone Marrow Examination
Erythroblasts
Parvovirus
Pancytopenia
Histiocytes
Passive Immunization
Hypertriglyceridemia
Intravenous Immunoglobulins
Viral DNA
Infection
Serum
L-Lactate Dehydrogenase
Kidney Transplantation

Keywords

  • Hemophagocytic lymphohistiocytosis
  • Intravenous immunoglobulin
  • Parvovirus B19
  • Renal transplantation
  • Thrombotic microangiopathy

ASJC Scopus subject areas

  • Immunology

Cite this

Postrenal transplant hemophagocytic lymphohistiocytosis and thrombotic microangiopathy associated with parvovirus B19 infection. / Ardalan, M. R.; Mohajel Shoja, Mohammadali; Tubbs, R. S.; Esmaili, H.; Keyvani, H.

In: American Journal of Transplantation, Vol. 8, No. 6, 01.06.2008, p. 1340-1344.

Research output: Contribution to journalArticle

Ardalan, M. R. ; Mohajel Shoja, Mohammadali ; Tubbs, R. S. ; Esmaili, H. ; Keyvani, H. / Postrenal transplant hemophagocytic lymphohistiocytosis and thrombotic microangiopathy associated with parvovirus B19 infection. In: American Journal of Transplantation. 2008 ; Vol. 8, No. 6. pp. 1340-1344.
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