Erythrovirus-B19-Induced Pure Red Cell Aplasia Revealing Untreated HIV Infection

BACKGROUND Pure red cell aplasia (PRCA) caused by human erythrovirus B19 is a rare condition typically associated with persistent anemia in immunocompromised hosts. Although erythrovirus B19 infection is usually self-limited in immunocompetent individuals, it may become chronic in patients with impaired immune function. Reports describing erythrovirus B19 as the initial manifestation leading to a diagnosis of human immunodeficiency virus (HIV) infection are exceedingly uncommon. CASE REPORT A previously healthy 23-year-old male university student presented with severe symptomatic anemia (hemoglobin 3.6 g/dL) requiring transfusional support. During hospitalization, he was newly diagnosed with HIV infection, with a baseline viral load of 811 000 copies/mL and CD4 count of 33 cells/µL. Antiretroviral therapy with tenofovir, lamivudine, and dolutegravir was initiated, along with prophylaxis comprising trimethoprim-sulfamethoxazole and folic acid supplementation. Two weeks later, the patient was readmitted with recurrent severe anemia. Extensive laboratory evaluation excluded nutritional deficiencies, hemolysis, opportunistic infections, and drug toxicity. Bone marrow biopsy confirmed PRCA. Polymerase chain reaction and serology testing confirmed acute erythrovirus B19 infection. The patient was treated with a single dose of intravenous immunoglobulin, which resulted in stabilization of hemoglobin levels and clinical improvement; there was no evidence of relapse during 3 months of follow-up. CONCLUSIONS Erythrovirus-B19-associated PRCA can be the first clinical clue to HIV infection. Early recognition and treatment with intravenous immunoglobulin may prevent recurrent anemia and improve outcomes in this vulnerable population.