19 May 2026
: Case report 
Erythrovirus-B19-Induced Pure Red Cell Aplasia Revealing Untreated HIV Infection
Challenging differential diagnosis, Rare disease
Pedro Moreno Fonseca
ABCDEF 1,2*, Jaysa Pizzi F 3,4, Frederico da Cunha Abbott BD 1, Gisele Oro Boff BDE 1,4, Andressa Noal AEF 1,2, Verônica Farias B 5, Irajane Assis de Albuquerque B 6, Nicole Reis EF 1,7
DOI: 10.12659/AJCR.952075
Am J Case Rep 2026; 27:e952075
Table 1 Laboratory findings at different time points.
| Laboratory finding | Community hospital | Admission (ID Ward) | After IVIG (discharge) | One-month follow-up | Three-month follow-up | Reference range |
|---|---|---|---|---|---|---|
| Hemoglobin (g/dL) | 3.6 | 6.2 | 7 | 10.8 | 13.5 | 13.5–17.5 |
| Hematocrit (%) | 7 | 19 | 21 | 33 | 41.5 | 41–53 |
| MCV (fL) | 80 | 84.6 | 86 | 84.1 | 86.7 | 80–100 |
| MCHC (g/dL) | 32 | 32.6 | 33 | 32.4 | 32.6 | 32–36 |
| RDW (%) | 14.4 | 13.8 | 13.3 | 15.3 | 18.9 | 11.5–14.5 |
| Leukocytes (×10/L) | 4.06 | 6.41 | 5.81 | 6.07 | 6.5 | 4.0–11.0 |
| Platelets (×10/L) | 200 | 325 | 261 | 248 | 258 | 150–400 |
| Reticulocytes (%) | 0.3 | 0.1 | 0.3 | 0.5–2.5 | ||
| PT (s) | * | 12.8 | * | * | * | 10–13 |
| aPTT (s) | * | 23.5 | * | * | * | 25–35 |
| INR | * | 1.2 | * | * | * | 0.8–1.2 |
| Serum iron (μg/dL) | * | 227 | * | * | * | 60–170 |
| Ferritin (ng/mL) | * | 530 | * | * | * | 30–400 |
| Transferrin saturation (%) | * | 25.6 | * | * | * | 20–50 |
| LDH (U/L) | * | 498 | * | * | * | 120–250 |
| Haptoglobin (mg/dL) | * | 153 | * | * | * | 30–200 |
| Direct Coombs test | * | Negative | * | * | * | Negative |
| Vitamin B12 (pg/mL) | * | 418 | * | * | * | 200–900 |
| Folate (ng/mL) | * | 8.5 | * | * | * | >4.0 |
| TSH (μIU/mL) | * | 1.48 | * | * | * | 0.4–4.0 |
| CD4 count (cells/mm) | 33 | 47 | * | 97 | 192 | 500–1500 |
| CD4/CD8 ratio | 0.04 | 0.05 | 0.12 | 0.14 | 1.0–3.5 | |
| HIV VL (copies/mL) | 811 000 | 604 | * | 266 | 36 | <20 |
| Creatinine (mg/dL) | 0.84 | 1.35 | * | * | * | 0.7–1.3 |
| AST (U/L) | 18 | 36 | * | * | * | 10–40 |
| ALT (U/L) | 18 | 29 | * | * | * | 7–56 |
| ALP (U/L) | 79 | 75 | * | * | * | 40–130 |
| Total bilirubin (mg/dL) | 0.23 | 0.3 | * | * | * | 0.2–1.2 |
| Direct bilirubin (mg/dL) | 0.07 | 0.2 | * | * | * | 0.0–0.3 |
| ID – infectious diseases; IVIG – intravenous immunoglobulin; MCV – mean corpuscular volume; MCHC – mean corpuscular hemoglobin concentration; RDW – red cell distribution width; PT – prothrombin time; aPTT – activated partial thromboplastin time; INR – international normalized ratio; LDH – lactate dehydrogenase; TSH – thyroid-stimulating hormone; HIV VL – HIV viral load; AST – aspartate aminotransferase; ALT – alanine aminotransferase; ALP – alkaline phosphatase. * Not available. | ||||||