European Journal of Internal Medicine
Volume 17, Issue 7 , Pages 505-507, November 2006

Parvovirus B19 reactivation presenting as neutropenia after rituximab treatment

  • A. Klepfish

      Affiliations

    • Hematology Institute, Wolfson Medical Centre, Tel Aviv and Sackler Medical School, Jerusalem, Israel
    • ,
  • E. Rachmilevitch

      Affiliations

    • Hematology Institute, Wolfson Medical Centre, Tel Aviv and Sackler Medical School, Jerusalem, Israel
    • ,
  • A. Schattner

      Affiliations

    • Department of Medicine, Kaplan Medical Center, Rehovot 76100 and Hebrew University Hadassah Medical School, Jerusalem, Israel
    • Corresponding Author InformationCorresponding author. Fax: +972 8 9441 719.

Received 24 January 2006; received in revised form 23 April 2006; accepted 11 May 2006.

Abstract 

A patient with primary biliary cirrhosis and associated refractory immune thrombocytopenic purpura was treated with 4 weekly courses of rituximab, a monoclonal antibody targeting B-cell surface antigen CD20. Her thrombocyte count and even cholestatic liver function tests improved. However, 17 weeks after rituximab treatment, she developed severe neutropenia (absolute neutrophil count 0.23×103/μl) and recurrent thrombocytopenia with abnormal bone marrow of all three lineages. Although delayed-onset neutropenia has been reported after rituximab, reactivated viral infections have also been encountered. Parvovirus B19 was suspected and confirmed as the cause of neutropenia in our patient. The patient was supported by GCSF treatment and recovered uneventfully after several weeks. Neutropenia after rituximab can also be the predominant manifestation of reactivated parvovirus B19 infection and have a favorable prognosis.

Keywords: Parvovirus B19, Rituximab, Immune thrombocytopenia, Neutropenia

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PII: S0953-6205(06)00190-7

doi:10.1016/j.ejim.2006.05.002

European Journal of Internal Medicine
Volume 17, Issue 7 , Pages 505-507, November 2006

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