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Autoimmune Hemolytic Anemia in Acute Coxsackievirus B Infection

Aguilar, Javier MD*; Zuberi, Lara MD; Arbulu, Ricardo MD; Reyes, Milagros P. MD§

Infectious Diseases in Clinical Practice: November 2010 - Volume 18 - Issue 6 - p 408-410
doi: 10.1097/IPC.0b013e3181db80af
Case Reports

Autoimmune hemolytic anemia triggered by several different viral infections is a well-recognized entity; however, the role of coxsackievirus B in this condition is unknown. We report the case of a 22-year-old previously healthy woman who presented with an acute febrile illness, with prominent gastrointestinal symptoms, and an acute myocarditis. The patient received supportive therapy and was hemodynamically stabilized, but fever persisted for 35 days after the onset of her symptoms. During the third week of her hospitalization, the patient developed a severe autoimmune hemolytic anemia. Result of Coombs test was positive. Drugs, malignancy, and rheumatologic diseases were ruled out as causes of anemia. Serological examination results showed a 4-fold increase in the titers of coxsackievirus B5 when acute sera were compared with convalescent sera, demonstrating an acute infection. The anemia responded to high-dose steroids and intravenous immunoglobulin. Coombs test became negative. We postulate that this patient's acute infection by coxsackievirus triggered the autoimmune hemolytic anemia. Similar case reports are needed to further support the hypothesis of this association.

From the *Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI; †Department of Hematology and Oncology, Henry Ford Hospital, Detroit, MI; ‡Division of Infectious Diseases, University of Illinois College of Medicine, Chicago, IL; and §Division of Infectious Diseases, Wayne State University, Detroit, Michigan.

Correspondence to: Javier Aguilar, MD, Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2010 Lippincott Williams & Wilkins, Inc.