Leukoerythroblastosis in a child with sickle cell disease - what’s the diagnosis?

TEACHING FILES (GRAND ROUNDS)

Leukoerythroblastosis in a child with sickle cell disease - what’s the diagnosis?

Tânia Cristina Parreira Lança Pessoa¹, Joana Pais de Faria², Ana Cristina Silva Paulo da Costa e Castro², Marisa Raquel Inácio de Oliveira², Raquel Dias Batista Maia².

¹Pediatric Department, Hospital Nossa Senhora do Rosário, Unidade Local de Saúde do Arco Ribeirinho, Barreiro, Portugal,
²Pediatric Hematology Unit, Hospital Dona Estefânia, Unidade Local de Saúde de São José, Lisboa, Portugal.

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Why this article important?

This atypical presentation of parvovirus B19 infection in a sickle cell disease (SCD) patient is the first case described in our country, to our knowledge. To date there are only 2 reported cases of SCD patients with leukoerythroblastosis associated with parvovirus B19 infection, so this is a contribution to science. Furthermore, it reminds us that in cases of sudden and severe hypoproliferative anemia, we must think about aplastic anemia secondary to infection, especially in those with SCD. It also alerts us that in the presence of leukorythroblastosis, it is important to investigate infectious agents, namely parvovirus B19, before carrying out invasive tests considering neoplastic disease.

Summary of article

This teaching file aims to present and explain an atypical presentation of parvovirus B19 infection in a sickle cell disease (SCD) patient. We describe a 7-year-old girl with SCD who showed sudden severe hypoproliferative anemia with leukoerythroblastosis. The latter is a rare condition, often associated with neoplastic disease and rarely with infection. Concern about a hematologic malignancy was raised; however, a parvovirus B19 infection was detected. The patient underwent supportive treatment with improvement and was discharged within 3 days. Given the clinical presentation and rapid resolution, the diagnosis of transient aplastic crisis and leukoerythroblastosis in the context of an acute parvovirus B19 infection was established. Acute viral infections can mimic myeloproliferative neoplasm, which appears to have been the case.

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