Cytomegalovirus-induced Pure Red Cell Aplasia Successfully Treated with Ganciclovir: A Case Report

Abstract

Background: Acquired pure red cell aplasia (PRCA) is a rare disease characterized by anemia, severe reticulocytopenia and absent to low bone marrow erythroid precursor cells. There are well-described associations of this disorder with thymomas, lymphoproliferative disorders, autoimmune disorders, certain drugs, and infectious agents. Among the infectious agents, the most common is parvovirus B19, this was rarely reported in association with Cytomegalovirus (CMV). Objective: To describe a rare case of acquired PRCA associated with CMV and its response to antiviral therapy. Methods: We present the clinical and laboratory data of our patient and reviewed the related published literature regarding PRCA, its etiology and response to treatment. Results: We describe a 64-year-old male who presented with symptomatic anemia. He had a normocytic, normochromic anemia associated with low reticulocyte count. Serum ferritin was elevated. Vitamin B12, folate levels, kidney and liver functions were normal. He was given blood transfusion with packed red cells, hematinics and erythropoietin (EPO) injections for 2 months but there was no response. Bone marrow aspiration and biopsy showed erythroid hypoplasia consistent with PRCA. He was assessed to have PRCA probably EPO-antibody induced. EPO was discontinued and he was started on steroids. After 3 months of steroids there was persistence of anemia and reticulocytopenia. EPO-antibody assay done prior to steroid therapy came out to be negative. He tested negative for Hepatitis A, B and C, Human Immunodeficiency virus, Epstein barr-virus and parvovirus B-19.CMV DNA viral load was elevated. He was started on ganciclovir which resulted to transfusion independence and normalization of hemoglobin. Conclusion: PRCA may be reversible. High viral load of CMV was detected through PCR. He was treated with antiviral therapy resulting into a favorable response.