{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T07:36:45Z","timestamp":1772264205199,"version":"3.50.1"},"reference-count":14,"publisher":"Associacao Brasileira de Transplantes de Orgaos","issue":"1","license":[{"start":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T00:00:00Z","timestamp":1723420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BJT"],"abstract":"<jats:p>A aplasia eritrocit\u00e1ria pura (PRCA) associada \u00e0 infe\u00e7\u00e3o por parvov\u00edrus B19 (PVB19) \u00e9 um importante diagn\u00f3stico a considerar em recetores de transplante renal (TR) que se apresentam com anemia persistente, nos quais outras etiologias foram exclu\u00eddas. A gest\u00e3o desses doentes representa um desafio, uma vez que a redu\u00e7\u00e3o da imunossupress\u00e3o (IS) para tratar a infe\u00e7\u00e3o v\u00edrica deve ser cautelosa pelo potencial aumento do risco de rejei\u00e7\u00e3o do aloenxerto. Os autores descrevem um caso de um homem de 43 anos com antecedentes de doen\u00e7a renal cr\u00f3nica de etiologia indeterminada que foi submetido a TR de um dador falecido ap\u00f3s morte circulat\u00f3ria em janeiro de 2021. No primeiro ano p\u00f3s-TR, o paciente foi internado repetidamente devido a PRCA associada ao PVB19 e necessitou de transfus\u00f5es de gl\u00f3bulos vermelhos e tratamento com imunoglobulina humana intravenosa (IVIG). A IS foi inicialmente ajustada com suspens\u00e3o do micofenolato de mofetil (MMF) e posteriormente alterada para um esquema TRANSFORM com prednisolona, tacrolimus e everolimus. Devido ao agravamento da fun\u00e7\u00e3o renal, foi realizada uma bi\u00f3psia renal que revelou rejei\u00e7\u00e3o aguda mediada por c\u00e9lulas T borderline com sinais significativos de cronicidade (50% de fibrose intersticial e atrofia tubular). Para garantir o controlo da infe\u00e7\u00e3o, a IS n\u00e3o foi aumentada. Considerando a recorr\u00eancia da PRCA associada ao PVB19 apesar do uso de um esquema IS TRANSFORM num paciente com disfun\u00e7\u00e3o cr\u00f3nica do aloenxerto e alto risco imunol\u00f3gico, foi iniciada terap\u00eautica de manuten\u00e7\u00e3o com IVIG (0,4 mg\/kg) a cada 4 semanas. Ap\u00f3s 9 meses de tratamento n\u00e3o foi identificada nenhuma recidiva. De forma a promover uma prescri\u00e7\u00e3o individualizada de IS, um ImmunoBiogram\u00ae foi recentemente realizado, estando a ser considerada uma redu\u00e7\u00e3o da IS que potencialmente permitir\u00e1 a suspens\u00e3o da terapia de manuten\u00e7\u00e3o com IVIG. O diagn\u00f3stico e tratamento da PRCA associada ao PVB19 s\u00e3o desafiadores. Relativamente \u00e0 doen\u00e7a recidivante, o tratamento prolongado com IVIG parece ser \u00fatil, mas mais estudos s\u00e3o necess\u00e1rios para estabelecer o seu papel. Tamb\u00e9m \u00e9 fundamental adaptar, tanto quanto poss\u00edvel, a IS ao perfil imunol\u00f3gico individual dos doentes para prevenir o uso excessivo de imunossupress\u00e3o.<\/jats:p>","DOI":"10.53855\/bjt.v27i1.603_port","type":"journal-article","created":{"date-parts":[[2024,8,17]],"date-time":"2024-08-17T09:06:56Z","timestamp":1723885616000},"source":"Crossref","is-referenced-by-count":0,"title":["Recorr\u00eancia de Aplasia Eritrocit\u00e1ria Pura Associada ao Parvov\u00edrus B19: Uma Doen\u00e7a Desafiante no Transplante Renal"],"prefix":"10.53855","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4601-0920","authenticated-orcid":false,"given":"N\u00faria","family":"Paulo","sequence":"first","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8616-3430","authenticated-orcid":false,"given":"Carolina","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de Viseu D\u00e3o Laf\u00f5es"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5799-0883","authenticated-orcid":false,"given":"Ana","family":"Cerqueira","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8626-9235","authenticated-orcid":false,"given":"Susana","family":"Sampaio","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1482-2024","authenticated-orcid":false,"given":"Manuel","family":"Pestana","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o"}]}],"member":"32043","published-online":{"date-parts":[[2024,8,12]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Sharma N, Bajwa R. 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