Walking the Tight Rope - Clinical Spectrum, Management and Outcomes of Parvovirus Infection in Postrenal Transplant Patients - Case Series

Background: Parvovirus B19 (PV B19) can cause significant morbidity in immunocompromised individuals, particularly renal transplant recipients. It often presents with refractory anemia and may lead to graft dysfunction or complications related to immunosuppression. Case Description: We conducted a retrospective review of renal transplant recipients at a tertiary care center from 2012 to 2024. Among 690 transplant patients, eight patients (1.15%) were diagnosed with PV B19 infection using polymerase chain reaction (PCR). Clinical features, management strategies, and outcomes were analyzed over a 6-month follow-up period. The median age was 29.5 years (range 20–55), with a male predominance (7:1). Most cases (87%) occurred within 6 months posttransplant. All patients were on triple immunosuppression, 3 had elevated tacrolimus (TAC) levels, and 2 had prior rejection episodes. All patients had anemia, and one had pancytopenia. Bone marrow biopsy in three patients confirmed parvovirus-related marrow suppression. All patients received intravenous immunoglobulins (IVIGs), and mycophenolate mofetil doses were reduced. Four patients required blood transfusions. Two experienced relapses requiring a second course of IVIG and conversion of immunosuppression to everolimus or cyclosporine. One patient developed antibody-mediated rejection postparvo, and three others had TAC toxicity-induced graft dysfunction. Conclusion: PV B19 should be considered an important differential in transplant recipients presenting with anemia. Early diagnosis using PCR, timely IVIG therapy, and individualized adjustment of immunosuppression are essential for achieving favorable outcomes. Although relapse and complications such as rejection and drug toxicity may occur, most patients demonstrated hematological recovery and preserved graft function. A careful balance of immunosuppression remains critical in managing these infections.