Human parvovirus B19 infection with GvHD-like erythema in two allogeneic stem cell transplant recipients

We report two cases of human parvovirus B19 infection as a rare but anticipated complication shortly after allogeneic peripheral blood stem cell transplantation (PBSCT), which were

self-limiting in their course.

The first patient was a 48-year-old female treated for secondary acute myeloid leukaemia (AML) FAB M2 following chemotherapy for breast cancer 7 years ago. She received a PBSCT in second

complete remission, from a matched unrelated donor, after conditioning with 2 Gy total-body irradiation, 120 mg/m2 fludarabine, 60 mg/kg cyclophosphamide and 30 mg/kg antithymocyte globulin.

Immunosuppressive therapy was initiated with cyclosporine and mycofenolate. One day before transplantation, the patient presented with sudden skin erythema, which soon resolved without any

treatment. On day 10 after PBSCT, she developed an erythematous itchy eruption of the skin on both arms and the neck line, initially reminiscent of acute graft-versus-host disease (aGvHD),

but subsequently very inconsistent in its appearance in that it migrated from the neck line to the abdomen and back and finally to both legs. This lasted for a period of 14 days. Our

differential diagnosis included early acute cutaneous GvHD, viral erythema and drug-induced erythema. The latter seemed unlikely as no new drug had been administered. To clarify the

diagnosis a skin biopsy was taken. Surprisingly, this turned out to be positive for parvovirus B19 upon polymerase chain reaction (PCR), as was a bone marrow aspirate (700 copies/ml) taken

at the same time. PCR from skin samples were not analysed quantitatively. Histology did not show any signs suggestive of GvHD but a nonspecific pattern of inflammation with distinct signs of

cytotoxicity, as is frequently seen in skin lesions because of viral infections. Blood was positive for parvovirus B19 immunoglobin G (IgG) before transplantation. Findings were negative

for parvovirus B19 IgM before, during and after the infection. Parvovirus B19 PCR in peripheral blood was also negative during and after the infection.

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