Fever, Fatigue, Headache, Myalgia

30 F Crohn’s dz presents w/ fever, fatigue, headache, myalgia. Son goes to daycare had transient fever 10 days ago. Pt has Hb 8, retic<0.5%. Diagnosis?

ParvovirusB19 recent sick contact son had slapped cheek rash. Bone marrow aspirate: giant pronormoblasts w/ multiple intranuclear inclusions and cytoplasmic projections (dog ear)

Reticulocyte count was less than 0.5%, indicates complete absence of a bone marrow response to the anemia (i.e., the absence of reticulocyte production) hypoproliferative anemia

Ddx: Deficiencies of folate, vitamin B12, and iron can lead to hypoproliferative anemia but her levels were normal

Ddx: Infiltrative processes involving bone marrow that can lead to hypoproliferative anemia include mycobacterial infection, granulomatous dz (sarcoidosis) myelofibrosis, lysosomal storage diseases &cancer. patient had no organ involvement suggestive of granulomatous dz or cancer

Ddx: Antibody-mediated pure red-cell aplasia can be induced by pregnancy, viral hepatitis, HIV infection, leukemia, lymphoma, thymoma, and autoimmune conditions.

Sudden onset of this patient’s anemia suggests a rapid process rather than a slowly developing autoimmune disease or cancer

Parvovirus directly infects erythrocytes & erythrocyte precursor cells & causes hypoproliferative anemia. fever, malaise, headache are typical. It causes failure of bone marrow to compensate for normal red-cell loss, thereby leading to a predictable decline in hemoglobin level




Spreads through respiratory secretions, such as saliva, sputum, or nasal mucus, when an infected person coughs or sneezes.


Treatment supportive

Originally tweeted by Indiana University Infectious Diseases Fellowship (@IUIDfellowship) on 16 December, 2020.

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