HIV – Associated Pure Red Cell Aplasia in the Absence of Parvovirus B19 and Zidovudine Exposure: A Rare Case Report

Abstract

Background: Pure red cell aplasia (PRCA) is an uncommon haematological disorder characterised by severe anaemia, reticulocytopenia, and selective suppression of erythroid precursors in the bone marrow, with preservation of other haematopoietic lineages. In patients with human immunodeficiency virus (HIV), PRCA is uncommon and is most frequently associated with parvovirus B19 infection or zidovudine therapy. HIV-associated PRCA in the absence of these common aetiologies is rare and poses a diagnostic challenge. Case Presentation: We report a case of PRCA in a 56-year-old HIV-positive woman receiving tenofovir, lamivudine, and dolutegravir (TLD), who presented with progressive fatigue and severe symptomatic anaemia requiring packed red blood cell transfusion. The patient reported easy fatigability and reduced appetite; however, she had no evidence of gastrointestinal or other bleeding. Bone marrow examination revealed reduced erythropoiesis with relative granulopoietic predominance and findings consistent with PRCA. There was no history of zidovudine exposure, and parvovirus B19 serology was negative. Although serology alone cannot completely exclude parvovirus B19 infection in immunocompromised individuals, the overall clinical, laboratory, and bone marrow findings supported a diagnosis of presumed HIV-associated PRCA after common causes had been excluded. Conclusion: This case demonstrates the importance of considering PRCA in the differential diagnosis of severe unexplained anaemia in patients with HIV, even in the absence of zidovudine exposure or positive parvovirus B19 serology. Early bone marrow examination is important for accurate diagnosis. Reporting such rare cases may improve clinical awareness and patient care.