24 y/o F with ESRD due to Henoch-Schönlein Purpura undergoes kidney transplant. The donor is her mother. Induced with ATG followed by Tacrolimus, Mycophenolate mofetil and prednisone.

Uneventful recovery with discharge creatinine of 0.7 mg/dL. TAC trough levels between 8-11 ng/ml . Discharge Hb of 12.1 g/dL. 2 months after surgery she notices mild fatigue and pallor, otherwise fairly asymptomatic.

On PE nothing stands out except for pallor. Lab only notable for Hb of 7.2 g/dL , normo, normo ,with normal WBC and platelet count. Anemia workup is extensive and turns up only remarkable for reticulocyte 0.29%, Haptoglobin of 89 mg/dL and a normal LDH. Subsequently, a bone marrow aspirate is done that reveals hypoplastic erythroid series and a few giant pronormoblast with nuclear inclusions as shown in fig below consistent with parvovirus B19 infection.

Blood B19 PCR comes back at 895000 copies. She is treated with 2 doses of IVIG 1 gr/kg/day on alternate days, transient discontinuation of MMF, with resolution of anemia.

Fortunately, no side effects of IVIG or other B19 manifestations occurred.