A case of severe congenital parvovirus-B19

Abstract

Background: Acute parvovirus-B19 affects 3.3–3.8% of pregnant women, with an 11% risk of fetal loss before 20 weeks. Neonatal outcomes depend on gestational age, maternal health, and early intervention, such as intrauterine transfusions and comprehensive neonatal care. This case demonstrates the challenges of managing severe persistent congenital parvovirus- B19 related complications in an extremely preterm neonate. Case Presentation Summary: At 22 weeks of gestation the fetus was diagnosed with hydrops fetalis, anemia that was treated twice with blood transfusions. The neonate was delivered at 24 weeks of gestation due maternal HELLP syndrome. At birth severe respiratory distress, generalized edema, hydropericardium, ascites and hepatomegaly were evident. Congenital parvovirus-B19 infection was confirmed by the presence of viral DNA in the blood. The ascites was drained twice and multiple erythrocytes, thrombocyte as well as 1 fresh plasma transfusions were required for persistent anemia and thrombocytopenia. Presence of parvovirus DNA in the blood was still found at 37 days of age and persistence of thrombocytopenia below 20 despite the transfusions lead to the decision of treatment with IVIG. A 6-day treatment course was administered resulting in stabilized platelet count. However, platelet count normalized only after additional IVIG doses were administered. Condition was complicated by cytomegalovirus infection, treated with valganciclovir. The infant also suffered other bacterial, fungal and viral infections but primary immunodeficiency was yet not confirmed. IVIG infusions were repeated every 3- 4 weeks and the infant was discharged after 120 days of hospitalization with normal cell counts. Learning Points/Discussion: Cytopenia caused by persistent congenital parvovirus-B19 infection might be difficult to manage. In the absence of specific antiviral treatment, IVIG therapy plays a critical role in improving clinical outcomes in patients with parvovirus-related complications.