Parvovirus B19 has rarely been associated with acute liver failure (ALF), which has a high mortality. Plasma exchange that usually acts as a bridge to liver transplantation removes toxins, antibodies, cytokines, and can correct coagulopathy while maintaining a euvolemic state. Pediatric data regarding its use are scarce. We report a case of 16-year-old girl with acute liver failure in stage 4 encephalopathy with coagulopathy due to parvovirus B19 who was successfully managed with high-volume therapeutic plasma exchange (TPE). We tried to use it as a treatment modality due to nonavailability of in-hospital transplant facilities. Parvovirus B19 may be an underdiagnosed cause of acute viral hepatitis. Therapeutic plasma exchange can act as a bridge to liver transplant (LT) or bridge to recovery especially in self-limiting illnesses such as viral hepatitis.
Bihari C, Rastogi A, Saxena P, Rangegowda D, Chowdhury A, Gupta N, et al. Parvovirus b19 associated hepatitis. Hepat Res Treat 2013;2013:472027. DOI: 10.1155/2013/472027.
Hillingsø JG, Jensen IP, Tom-Petersen L. Parvovirus B19 and acute hepatitis in adults. e Lancet 1998;351(9107):955–956. DOI: 10.1016/S0140-6736(05)60609-5.
Krygier DS, Steinbrecher UP, Petric M, Erb SR, Chung SW, Scudamore CH, et al. Parvovirus B19 Induced hepatic failure in an adult requiring liver transplantation. World J Gastroenterol 2009;15(32):4067–4069. DOI: 10.3748/wjg.15.4067.
Kim BJ, Yoo KH, Li K, Kim MN. Parvovirus B19 infection associated with acute hepatitis in infant. Pediatr Infect Dis J 2009;28(7):667. DOI: 10.1097/INF.0b013e3181a645bd.
Sun L, Zhang JC. Acute fulminant hepatitis with bone marrow failure in an adult due to parvovirus B19 infection. Hepatology 2012;55(1):329–330. DOI: 10.1002/hep.24720.
Morita E, Nakashima A, Asao H, Sato H, Sugamura K. Human parvovirus B19 nonstructural protein (NS1) induces cell cycle arrest at G1 phase. J Virol 2003;77(5):2915–2921. DOI: 10.1128/jvi.77.5.2915-2921.2003.
Singer AL, Olthoff KM, Kim H, Rand E, Zamir G, Shaked A. Role of plasmapheresis in the management of acute hepatic failure in children. Ann Surg 2001;234(3):418–424. DOI: 10.1097/00000658-200109000-00015.
Bernal W, Wendon J. Acute liver failure. N Engl J Med 2013;369(26): 2525–2534. DOI: 10.1056/NEJMra1208937.
Larsen FS, Schmidt LE, Bernsmeier C, et al. High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial. J Hepatol 2016;64(1):69–78. DOI: 10.1016/j.jhep.2015.08.018.
Stahl K, Hadem J, Schneider A, Manns MP, Wiesner O, Schmidt BMW, et al. Therapeutic plasma exchange in acute liver failure. J Clin Apher 2019;34(5):589–597. DOI: 10.1002/jca.21737.
Maheshwari A, Bajpai M, Patidar GK. Effects of therapeutic plasma exchange on liver function test and coagulation parameters in acute liver failure patients. Hematol Transfus Cell Ther 2019. pii: S2531-1379(19)30102-6 10.1016/j.htct.2019.05.003.