BACKGROUND Acquired pure red cell aplasia(aPRCA)related to human parvovirus B19(HPV B19)is rarely reported in simultaneous pancreas-kidney transplantation(SPKT)recipients;there has yet to be a case report of early pos...BACKGROUND Acquired pure red cell aplasia(aPRCA)related to human parvovirus B19(HPV B19)is rarely reported in simultaneous pancreas-kidney transplantation(SPKT)recipients;there has yet to be a case report of early postoperative infection.In this current study,we report the case of a Chinese patient who experienced the disease in the early postoperative period.CASE SUMMARY A 63-year-old man,with type 2 diabetes and end-stage renal disease,received a brain dead donor-derived SPKT.Immunosuppression treatment consisted of tacrolimus,prednisone,enteric-coated mycophenolate sodium(EC-MPS),and thymoglobulin combined with methylprednisolone as induction.The hemoglobin(Hb)level declined due to melena at postoperative day(POD)3,erythropoietinresistant anemia persisted,and reticulocytopenia was diagnosed at POD 20.The bone marrow aspirate showed decreased erythropoiesis and the presence of giant pronormoblasts at POD 43.Metagenomic next-generation sequencing(mNGS)of a blood sample identified HPV B19 infection at POD 66.EC-MPS was withdrawn;three cycles of intravenous immunoglobulin(IVIG)infusion therapy were administered;and tacrolimus was switched to cyclosporine.The HPV B19-associated aPRCA resolved completely and did not relapse within the 1-year follow-up period.The diminution in mNGS reads was correlated with Hb and reticulocyte count improvements.CONCLUSION HPV B19-associated aPRCA can occur at an early period after SPKT.An effective therapy regimen includes IVIG infusion and adjustment of the immunosuppressive regimen.Moreover,mNGS can be used for the diagnosis and to reflect disease progression.展开更多
Background:The incidence of acute symptomatic(at the time of documented brain insult)seizures and single unprovoked seizures are 29-39 and 23-61 per 100000 per year,respectively.After stabilization of the patient,fi n...Background:The incidence of acute symptomatic(at the time of documented brain insult)seizures and single unprovoked seizures are 29-39 and 23-61 per 100000 per year,respectively.After stabilization of the patient,fi nding the etiology of the seizure is of paramount importance.A careful history and physical examination may allow a diagnosis without need for further evaluation.Methods:In the literature,severe central nervous system involvement has been reported from human parvovirus B19 infection.We reported a previously healthy 7-year-old girl who presented after an episode of focal seizure.She was afebrile and didn't have any focal neurological abnormalities.She had erythematous malar rash along with reticulating pattern of rash over her both upper extremities.Results:Parvovirus infection was suspected due to the characteristic erythematous malar rash.Serum human parvovirus B19 DNA polymerase chain reaction was positive which was consistent with acute parvovirus infection.Further confirmation of current infection was done with Sandwich enzyme immunoassays showing positive anti-B19 IgM Index(>1.1).IgG index was equivocal(0.9-1.1).Conclusions:We report an extremely rare presentation of non-febrile seizure from acute parvovirus infection in a child without encephalopathy who had an excellent recovery.Timely diagnosis can provide counselling regarding future seizure recurrence risk,curtail expenditure from expensive diagnostic work up and provide additional recommendations about potential risks to a pregnant caregiver.展开更多
基金National Natural Science Foundation of,No.81970654.
文摘BACKGROUND Acquired pure red cell aplasia(aPRCA)related to human parvovirus B19(HPV B19)is rarely reported in simultaneous pancreas-kidney transplantation(SPKT)recipients;there has yet to be a case report of early postoperative infection.In this current study,we report the case of a Chinese patient who experienced the disease in the early postoperative period.CASE SUMMARY A 63-year-old man,with type 2 diabetes and end-stage renal disease,received a brain dead donor-derived SPKT.Immunosuppression treatment consisted of tacrolimus,prednisone,enteric-coated mycophenolate sodium(EC-MPS),and thymoglobulin combined with methylprednisolone as induction.The hemoglobin(Hb)level declined due to melena at postoperative day(POD)3,erythropoietinresistant anemia persisted,and reticulocytopenia was diagnosed at POD 20.The bone marrow aspirate showed decreased erythropoiesis and the presence of giant pronormoblasts at POD 43.Metagenomic next-generation sequencing(mNGS)of a blood sample identified HPV B19 infection at POD 66.EC-MPS was withdrawn;three cycles of intravenous immunoglobulin(IVIG)infusion therapy were administered;and tacrolimus was switched to cyclosporine.The HPV B19-associated aPRCA resolved completely and did not relapse within the 1-year follow-up period.The diminution in mNGS reads was correlated with Hb and reticulocyte count improvements.CONCLUSION HPV B19-associated aPRCA can occur at an early period after SPKT.An effective therapy regimen includes IVIG infusion and adjustment of the immunosuppressive regimen.Moreover,mNGS can be used for the diagnosis and to reflect disease progression.
文摘Background:The incidence of acute symptomatic(at the time of documented brain insult)seizures and single unprovoked seizures are 29-39 and 23-61 per 100000 per year,respectively.After stabilization of the patient,fi nding the etiology of the seizure is of paramount importance.A careful history and physical examination may allow a diagnosis without need for further evaluation.Methods:In the literature,severe central nervous system involvement has been reported from human parvovirus B19 infection.We reported a previously healthy 7-year-old girl who presented after an episode of focal seizure.She was afebrile and didn't have any focal neurological abnormalities.She had erythematous malar rash along with reticulating pattern of rash over her both upper extremities.Results:Parvovirus infection was suspected due to the characteristic erythematous malar rash.Serum human parvovirus B19 DNA polymerase chain reaction was positive which was consistent with acute parvovirus infection.Further confirmation of current infection was done with Sandwich enzyme immunoassays showing positive anti-B19 IgM Index(>1.1).IgG index was equivocal(0.9-1.1).Conclusions:We report an extremely rare presentation of non-febrile seizure from acute parvovirus infection in a child without encephalopathy who had an excellent recovery.Timely diagnosis can provide counselling regarding future seizure recurrence risk,curtail expenditure from expensive diagnostic work up and provide additional recommendations about potential risks to a pregnant caregiver.
