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Case Reports in Hepatology
Volume 2017 (2017), Article ID 1359486, 5 pages
https://doi.org/10.1155/2017/1359486
Case Report

Severe Aplastic Anemia following Parvovirus B19-Associated Acute Hepatitis

1Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
2Second Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
3Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
4Division of Gastroenterology, Bell Land General Hospital, Sakai, Osaka, Japan

Correspondence should be addressed to Kosuke Kaji

Received 14 February 2017; Accepted 12 April 2017; Published 20 April 2017

Academic Editor: Melanie Deutsch

Copyright © 2017 Masanori Furukawa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Human parvovirus (HPV) B19 is linked to a variety of clinical manifestations, such as erythema infectiosum, nonimmune hydrops fetalis, and transient aplastic anemia. Although a few cases have shown HPVB19 infection as a possible causative agent for hepatitis-associated aplastic anemia (HAAA) in immunocompetent patients, most reported cases of HAAA following transient hepatitis did not have delayed remission. Here we report a rare case of severe aplastic anemia following acute hepatitis with prolonged jaundice due to HPVB19 infection in a previously healthy young male. Clinical laboratory examination assessed marked liver injury and jaundice as well as peripheral pancytopenia, and bone marrow biopsy revealed severe hypoplasia and fatty replacement. HPVB19 infection was diagnosed by enzyme immunoassay with high titer of anti-HPVB19 immunoglobulin M antibodies. Immunosuppressive therapy was initiated 2 months after the onset of acute hepatitis when liver injury and jaundice were improved. Cyclosporine provided partial remission after 2 months of medication without bone marrow transplantation. Our case suggests that HPVB19 should be considered as a hepatotropic virus and a cause of acquired aplastic anemia, including HAAA.