A Rare Case of Parvovirus B19 Infection Induced Paroxysmal Cold Hemoglobinuria in an Adult Female

Paroxysmal cold hemoglobinuria (PCH) is a rare form of autoimmune hemolytic anemia (AIHA). PCH occurs in acute and chronic forms. The main risk factors for PCH include viral infections, vaccination, and syphilis. PCH presentations are common in the pediatric population. The occurrence of PCH following parvovirus B19 infection in adults is rare. We report a case of a 23-year-old female who presented with giddiness, fatigue, greying of vision, and presyncope for four days, on subsequent evaluation was found to have evidence of hemolysis and bone marrow suppression. Parvoviral intranuclear inclusions were detected in bone marrow biopsy and parvoviral B19 IgM antibody was detected. Donath Landsteiner antibody test was also positive. Hence a diagnosis of PCH secondary to parvovirus B19 infection was made. She was started on pulse dose steroids and intravenous immunoglobulin (IVIG) and showed significant improvement.