Unusual Cause of Acute Hepatitis and Anemia in a Patient With HIV

Abstract

Introduction: Parvovirus B19 is a single-stranded DNA virus that usually results in a common infection that occurs during childhood. Most acute symptoms in children are asymptomatic. A 22-year-old male with history of HIV presented to the emergency room with history of severe fatigue, nausea, and diarrhoea for 2 weeks. He subsequently developed syncope. His physical examination was significant for pallor. His initial laboratory evaluation showed HGB 2.3 g/dL, retic count 8%, LDH 683, haptoglobin 210, direct Coombs negative, INR 1.6, total bilirubin 2.1, AST 1589, ALT 1288, negative serologies for CMV, HCV Ab, HBs Ag, CMV, HSV, and adenovirus. HIV Ab +, CD4 count 11, HIV RNA 58,941 copies/mL. Parvovirus B19 IgG was positive while IgM was negative. A liver biopsy (attached) showed “patchy mild zone 3 hepatocyte necrosis with minimal associated inflammation.” The patient continues to have anemia despite multiple PRBC transfusion. Then Serum parvovirus B19 DNA was ordered and came back +ve. The patient started on a 7-day-course of IVIG after consultation with hematology team. His HGB and liver enzymes start to improve. The patient was discharged in good condition from the hospital after recovery. His lab on discharge: HGB 7.9 g/dL, AST 277, and ALT 78 (Figure 1 and 2). Parvovirus B19 is a rare cause of sever hepatitis and anemia in HIV- infected persons. The early consideration of this condition will help in early diagnosis and prevent extensive work-up in those patents. The -ve parvovirus IgM can be misleading because of the immune status of those patients. Parvovirus PCR is important in diagnosis.Figure 1Figure 2