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Chronic autoimmune thrombopenia/neutropenia in a boy with persistent parvovirus B19 infection
W Scheurlen1, K Ramasubbu, O Wachowski
1Universitäts-Kinderklinik Mannheim, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany. w.scheurlen@kikli.ma.uni-heidelberg.de
Objective:
We report an 11-year-old boy presenting with splenomegaly, chronic thrombocytopenia and concordant neutropenia.
Results:
In contrast to autoantibodies against platelets, there were no detectable neutrophil-specific autoantibodies present in this patient. Extensive serologic investigations revealed increased IgM- and IgG-antibody titers against parvovirus B19. A nested polymerase chain reaction (PCR) showed parvovirus B19-specific sequences in the patient's bone-marrow cells but not in the serum. Specific antibodies against the structural proteins VP1 and VP2 in addition to those against non-structural protein NS1 of parvovirus B19 were detected by Western blot analysis. Thrombocytopenia and neutropenia responded to immunosuppressive therapy and subsequent splenectomy, the latter being necessary due to severe side-effects of steroid medication.
Conclusion:
Autoimmune thrombocytopenia/neutropenia may have been triggered and/or sustained by a chronic parvovirus B19 infection. Patients with this very rare disorder should be screened for this virus.