A Man with Pancytopenia

He had developed transfusion-dependent anemia with evolving pancytopenia in the 3 months after transplantation. Cytopenias worsened despite reduction of immunosuppressive medications, and endomyocardial biopsies ruled out allograft rejection. Further evaluation was notable for profound reticulocytopenia, elevated ferritin and transferrin saturation, and splenomegaly. The patient underwent a bone marrow biopsy, and histopathology showed giant proerythroblasts with eosinophilic intranuclear inclusions (Figure 1), indicative of infection with parvovirus B19.