Parvovirus B19-triggered Acute Hemolytic Anemia and Thrombocytopenia in a Child with Evans Syndrome.

BACKGROUND: Human parvovirus B19 (HPV-B19) is the etiologic agent of erythema infectiosum, of transient aplastic crises in individuals with underlying chronic hemolytic disorders, and of chronic pure red cell aplasia in immunocompromised individuals. CASE REPORT: We describe a 14-year-old girl with long-standing Evans syndrome, who presented with severe anemia, reticulocytopenia and thrombocytopenia. A bone marrow aspirate revealed severe erythroid hypoplasia along with the presence of giant pronormoblasts, while serological studies and real-time PCR of whole blood were positive for acute parvovirus B19 infection. The patient was initially managed with corticosteroids, but both cytopenias resolved only after administration of intravenous gamma globulin 0.8g/kg. CONCLUSION: Acute parvovirus B19 infection should be suspected in patients with immunologic diseases, who present reticulocytopenic hemolytic anemia and thrombocytopenia. In this setting, intravenous gamma globulin is effective for both cytopenias.

Extensive cutaneous anthrax in an immunocompetent patient.

Bacillus anthracis disease constitutes an extremely important worldwide epidemiological problem. Interest in cutaneous anthrax resides in its skin manifestations, course, diagnostic methods and management. An extensive cutaneous anthrax of the whole left upper arm, accompanied by lymphadenopathy and high fever, in a 60 year-old male patient, a shepherd by profession, is reported. He was treated effectively by intravenously administered ciprofloxacin and clindamycin. In the event of clinical suspicion of cutaneous anthrax, the patient has to be treated by the recommended regimen of antibiotics because of the possibility of evolvution to an extensive or severe systemic disease, even in the absence of immuno-depressant factors.