A case of human parvo virus B 19 infection with erythroid hypoplasia and Idiopathic thrombocytopenic purpura in an immunocompetent child: a case report

Abstract

Human parvo virus B19 (B19V) is a small (5.5kb) single stranded DNA (deoxy ribo nucleic acid) virus with known tropism and cytotoxicity for erythroid progenitors. Human parvovirus B19 infection is associated with various hematological disorders like aplastic crisis, erythroid hypoplasia and idiopathic thrombocytopenic purpura. Here we are presenting a rare case of parvo virus B19 infection with erythroid hypoplasia and idiopathic thrombocytopenic purpura occurring simultaneously in a 13year old girl who presented with fever and bleeding manifestations. A 13 year old girl presented with fever of 5 days duration, epistaxis and bleeding gums spontaneously of one day duration. On admission she had pancytopenia. Her B12 and folate levels were within normal range. Bone marrow aspiration suggestive of normal cellularity with paucity of erythroid precursors, myeloid: erythroid ratio 9:1 and gaint basophilic pronormoblasts with intra-nuclear inclusions, with no further maturation, as well as increased megakaryocytes with few hypolobate forms suggestive of erythroid hypoplasia and idiopathic thrombocytopenic purpura. Parvo virus B19 DNA PCR by nested polymerase chain reaction was detected in serum. She was treated with blood component support and with steroids for idiopathic thrombocytopenic purpura. She recovered and her cell counts are improved. This case highlights the morphology of Human parvo virus B19 inclusions and its association with simultaneous presentation of erythroid hypoplasia and idiopathic thrombocytopenic purpura in immunocompetent child, which is very rare.