Parvovirus Infection and Severe Anemia in an Hiv-Positive Patient

Parvovirus B19 infection has tropism for erythroid precursor cells in the bone marrow and is transmitted by respiratory droplets, usually causing asymptomatic or nonspecific disease. In immunosuppressed patients, due to reduced immune response, it may progress to severe acute anemia and chronic anemia due to persistent erythroid aplasia. Diagnosis is made by IgM serology or, in immunosuppressed patients, by detection of B19 DNA in serum or bone marrow. Female patient, 54 years old, diagnosed with HIV since 2013, with a history of poor adherence to antiretroviral therapy (ART), multiple opportunistic infections over the years, and critically low CD4 count (5 cells/mm³). In August 2024, while receiving ganciclovir for cytomegalovirus (CMV) colitis, she developed pallor, hypotension, and “transparent”-appearing blood during peripheral venipuncture. She was referred to hospital, where severe anemia was diagnosed (hemoglobin 2 g/dL). During hospitalization, she received blood transfusions and underwent bone marrow biopsy. Histopathology revealed a hypercellular marrow with hyperplasia and dysplasia of erythroid and megakaryocytic lineages, along with giant proerythroblasts with eosinophilic viral inclusions, compatible with Parvovirus B19 infection. Treatment consisted of transfusion support only, as immunoglobulin was unavailable in the hospital. This case illustrates the clinical impact of advanced immunosuppression in a patient with irregular ART adherence. The CD4 count of 5 cells/mm³ indicates profound immunosuppression, predisposing to opportunistic infections. In patients with ineffective immune responses, parvovirosis tends to course with persistent viral replication, leading to severe anemia and thrombocytopenia. Due to impaired antibody production and immune complex formation, serology is not indicated; diagnosis relies on detection of B19 DNA or bone marrow biopsy. This case reinforces the importance of multidisciplinary strategies in patients with advanced HIV, including psychosocial support, ART regimen reassessment, and adherence support. It also highlights the lack of adequate hematologic support, given the unavailability of immunoglobulin therapy. The case underscores the need for clinical suspicion of parvovirosis as a cause of severe anemia in HIV-positive patients, as well as the central role of ART in immune reconstitution and clinical improvement.