Parvovirus B19-Infected Tubulointerstitial Nephritis in Hereditary Spherocytosis

Kei Nishiyama; Yuka Watanabe; Masataka Ishimura; Kenichi Tetsuhara; Takashi Imai; Hikaru Kanemasa; Kenji Ueki; Yoshitomo Motomura; Noriyuki Kaku; Yasunari Sakai; Ken-Ichi Imadome; Shouichi Ohga

doi:10.1093/ofid/ofaa288

Parvovirus B19-Infected Tubulointerstitial Nephritis in Hereditary Spherocytosis

Open Forum Infect Dis. 2020 Jul 6;7(8):ofaa288. doi: 10.1093/ofid/ofaa288. eCollection 2020 Aug.

Affiliations

¹ Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Pediatric Intensive Care Unit, Kyushu University Hospital, Fukuoka, Japan.
³ Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁴ Department of Advanced Medicine for Infections, National Center for Child Health and Development, Tokyo, Japan.

Abstract

Background: Human parvovirus B19 (B19V) causes glomerulopathy or microangiopathy, but not tubulopathy. We experienced an 11-year-old girl with spherocytosis who developed acute kidney injury on a primary infection of B19V. She presented with anuria, encephalopathy, thrombocytopenia, and coagulopathy, along with no apparent aplastic crisis.

Methods: Continuous hemodiafiltration, immunoglobulin, and intensive therapies led to a cure.

Results: A kidney biopsy resulted in a histopathological diagnosis of tubulointerstitial nephritis without immune deposits. The virus capsid protein was limitedly expressed in the tubular epithelial cells with infiltrating CD8-positive cells.

Conclusions: Viral and histopathological analyses first demonstrated B19-infected tubulointerstitial nephritis due to the aberrant viremia with hereditary spherocytosis.

Keywords: parvovirus B19; spherocytosis; tubulointerstitial nephritis.