Central nervous system vasculitis secondary to parvovirus B19 infection in a pediatric renal transplant patient

Central nervous system (CNS) vasculitis secondary to chronic parvovirus B19 (B19) infection presenting with recurrent neurological findings is a very rare disorder during childhood. Here we report a 12-year-old boy with a renal transplant who had chronic B19 infection with skin eruptions and recurre...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2005-04, Vol.20 (4), p.529-533
Main Authors: Bilge, Ilmay, Sadikoğlu, Banu, Emre, Sevinç, Sirin, Aydan, Aydin, Kubilay, Tatli, Burak
Format: Article
Language:English
Subjects:
Brain Diseases - diagnosis
Brain Diseases - virology
Care and treatment
Case studies
Central nervous system
Child
Chronic Disease
Health aspects
Humans
Immunoglobulins, Intravenous - therapeutic use
Immunosuppression
Kidney Transplantation - adverse effects
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Parvoviridae Infections - etiology
Parvoviridae Infections - therapy
Parvovirus B19, Human
Parvovirus infections
Vasculitis
Vasculitis, Central Nervous System - virology
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Summary:Central nervous system (CNS) vasculitis secondary to chronic parvovirus B19 (B19) infection presenting with recurrent neurological findings is a very rare disorder during childhood. Here we report a 12-year-old boy with a renal transplant who had chronic B19 infection with skin eruptions and recurrent episodes of encephalopathy with focal neurological deficits. B19 DNA was detected in blood, bone marrow, and skin biopsy specimens. Repeat cranial magnetic resonance (MR) imaging during each episode of encephalopathy showed variable focal findings, and MR angiography revealed vasculitic changes with narrowing of the cerebral arteries. We hypothesized that the CNS vasculitis might be associated with the chronic B19 infection. At the time of his fourth presentation with the same clinical findings, we administered intravenous immunoglobulin (IVIG) (1 g/kg per day, 2 consecutive days), which we continued for 6 months, at monthly intervals. IVIG therapy resulted in remission and has been effective not only for the clearance of B19, but also for the improvement of clinical and radiological findings of CNS vasculitis. We suggest that chronic B19 infection should be considered in immunocompromised patients with suspected CNS vasculitis. IVIG should be considered as a part of the treatment.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-004-1736-1