Parvovirus B19-associated transient pure red cell aplasia with lymphadenopathy: a case report

There have been few reports on lymph node swelling in human parvovirus (HPV) B19 infection. A report of a 42-year-old female, who developed HPV B19-associated transient red cell aplasia with lymphadenopathy, is presented. The lymph node swelling began with the appearance of atypical lymphocytes in the peripheral blood and it disappeared as the patient recovered from the aplasia. Microscopically, the patient's bone marrow showed characteristic giant proerythroblasts with no maturation of the erythroid series. An excised inguinal lymph node showed florid, reactive follicular hyperplasia with paracortex expansion, and neutrophil infiltration and hemophagocytosis in the medullary sinus. These findings were compatible with the histology of a viral infection. A polymerase chain reaction study revealed HPV B19 in her serum and lymph node, but an immunohistochemical study failed to demonstrate HPV B19 capsid antigen in the lymph node or bone marrow. Although the present case suggests that reactive lymphadenopathy is associated with HPV B19 infection, the mechanism of the lymph node swelling still remains to be elucidated.