Page 95 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 3 Case Report

14 Transfusion of red cell conc. Transfusion of red cell conc. + IV immunoglobulin

FTC started
12

10
Haemoglobin g/dl 8 6

4

2

FTC stopped
0
2014/06/10 2014/09/18 2014/12/27 2015/04/06 2015/07/15 2015/10/23 2016/01/31 2016/05/10
Date
FIGURE 1: Changes in haemoglobin over time.

The Department of Infectious Diseases was then consulted has asymptomatic PVB19 viremia, which has been described
for further management. A second positive blood PVB19 in < 1% of well blood donors. 11
qualitative PCR prompted continued treatment for PVB19-
induced PRCA. In summary, we describe a case of PRCA, initially
presumed to be secondary to chronic PVB19 infection that
Over the following 11 months, she presented numerous times failed to respond to multiple courses of IVIG, but promptly
with symptomatic anaemia and received more than 53 units resolved after discontinuing emtricitabine. This case
of packed red blood cells as well as six courses of IVIG at provides strong circumstantial evidence that emtricitabine
doses ranging from 0.4 mg/kg/day to 1 g/kg/day for 5 days. played an etiologic role in the PRCA. This would be the
At no point did she demonstrate a reticulocyte response. fifth case of PRCA, implicating emtricitabine, reported
9
A repeated bone marrow aspirate and trephine biopsy done from South Africa. 7
7 months after the first bone marrow examination did not
contribute anything further. She remained adherent to ART Acknowledgements
and was virologically suppressed throughout.
Competing interests
What was striking was that the problem of symptomatic The authors have no conflict of interests.
transfusion requiring anaemia arose after starting ART,
which suggested that the drugs could be playing a role. Authors’ contributions
The close structural relationship between lamivudine
and emtricitabine, and the rare but well-accepted fact N.M. and C.D.P. contributed to the literature search, data
that lamivudine is associated with PRCA, led us to collection, analysis, interpretation and writing; Y.S.M.
implicate emtricitabine in this patient. A similar case of and R.J.L. contributed to analysis, interpretation, writing and
5,6
emtricitabine-induced PRCA was described in 2015 in a editing; B.I.G. contributed to data collection, analysis,
39-year-old pregnant woman. We do not believe pregnancy and writing. M.-A.A.J. and T.C.M. contributed to analysis
10
had any role in the pathogenesis of PRCA in our patient and interpretation.
because resolution occurred 1 year after delivery and
promptly after discontinuing emtricitabine. Her ART Ethical considerations
regimen was changed to abacavir, tenofovir and efavirenz, Approval was obtained from the Biomedical Research and
resulting in a dramatic change in her condition. Her Hb Ethics Committee on 22 March 2016, since it extended no risk
spontaneously improved and she became transfusion- to the patient. BREC reference number EXM188/16.
independent and remained so for the following 2 years of
follow-up (Figure 1).
Funding
Interestingly, the qualitative PVB19 PCR remained positive This research received no specific grant from any funding
a year after recovery of her Hb. We suspect our patient agency in the public, commercial or not-for-profit sectors.

http://www.sajhivmed.org.za 88 Open Access