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Unusual bone marrow manifestations of parvovirus B19 infection in immunocompromised patients. Hum Pathol 2000 Feb;31(2):161-8

Date

02/24/2000

Pubmed ID

10685629

DOI

10.1016/s0046-8177(00)80215-4

Scopus ID

2-s2.0-0033981019   44 Citations

Abstract

Parvovirus B19 is responsible for a spectrum of disease in humans. The usual bone marrow findings in acute parvovirus infections are marked erythroid hypoplasia and occasional giant erythroblasts. Intranuclear inclusions in developing erythroid precursors are rarely described in children or adults with parvovirus infection, although abundant intranuclear inclusions are commonly observed in the placenta and other tissues in infected fetuses. In this study, 8 patients are reported in whom the first evidence of parvovirus infection was the recognition of numerous intranuclear inclusions in erythroid precursors on bone marrow biopsy sections. Six of the 8 patients had documented immunodeficiencies; 4 had acquired immune deficiency syndrome (AIDS), and 2 were on chemotherapy. Five of 7 patients were negative for immunoglobulin G (IgG) antiparvovirus antibodies, including all 4 with AIDS. Unlike the typical pattern in parvovirus infection, the bone marrow was hypercellular in most of the patients, and erythroid precursors were usually increased with the entire spectrum of normoblast maturation represented; abundant intranuclear inclusions were observed similar to the finding in fetuses. The inclusions were variably eosinophilic and compressed the chromatin against the nuclear membrane. In situ hybridization showed parvovirus B19 DNA in numerous erythroid precursors in all cases. The findings of erythroid maturation and abundant viral inclusions in these immunocompromised patients is consistent with the hypothesis that failure to produce effective IgG parvovirus neutralizing antibodies may lead to persistent infection through viral tolerance that allows erythroid development of infected cells past the pronormoblast stage. Identification of parvovirus inclusions in marrow biopsies and subsequent confirmation of infection by in situ hybridization can be important in the assessment of anemia in immunodeficient patients because serological studies for parvovirus B19 are frequently negative.

Author List

Crook TW, Rogers BB, McFarland RD, Kroft SH, Muretto P, Hernandez JA, Latimer MJ, McKenna RW

Author

Steven Howard Kroft MD Chair, Professor in the Pathology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Acquired Immunodeficiency Syndrome
Adult
Anemia
Antineoplastic Agents
Biopsy
Bone Marrow
Cell Nucleus
Child
DNA, Viral
Erythrocytes
Erythroid Precursor Cells
Female
Humans
Immunocompromised Host
Inclusion Bodies
Leukemia, Lymphoid
Male
Microscopy, Electron
Middle Aged
Parvoviridae Infections
Parvovirus B19, Human