Case Presentation

A 49 year-old African-American male presented to ThomasJefferson University Hospital in April of 2008 complaining ofgeneralized weakness and lightheadedness for 4 months. Thepatient had a medical history of HIV/AIDS diagnosed in 2002with a CD4 count of 0 cells/mm3 in 2005 and a history of noncompliancewith highly active retroviral therapy (HAART). InDecember of 2007 the patient was diagnosed with cryptococcalmeningitis and had a concomitant anemia with a hemoglobinof 5.3 g/dL. At that time laboratory studies for parvovirus B19(PB19) showed an IgG of 0.79 units and an IgM of 0.63 units( a value less than 0.89 is considered negative). PB19 DNA byPCR or direct DNA hybridization was not checked at that time.A bone marrow biopsy was performed in January of 2008 todetermine the etiology of this severe hypoproliferative anemia,revealing hypercellular marrow containing maturing trilineagehematopoiesis with occasional non-caseating granulomaswith fungal elements. It was felt at this time that the anemiawas secondary to cryptococcal invasion of the bone marrow.The patient was treated for cryptococcal meningitis withfluorocytosine and liposomal amphotericin B for 2 weeks,followed by oral fluconazole indefinitely, and was dischargedfrom the hospital.