Figure 2.

A, B. The patient was diagnosed as having recurrent AIHA associated with PRCA caused by HPV B19 infection. The recurrent AIHA was treated with PSL 30 mg/day, however, the Hb level did not improve, remaining at 4 to 6 g/dL. The reticulocyte count increased to 0.4%, suggesting a tendency towards improvement of the PRCA. One week after admission, the patient again developed fever (body temperature 41 degrees Celsius). Bone marrow examination was performed again, which led to the diagnosis of HPS. Methylprednisolone pulse therapy resulted in resolution of the HPS, as well as of the AIHA and PRCA. Subsequently, the patient was treated with PSL at the dose of 60 mg/day. The PSL treatment was completed in January 2014. The patient has had no recurrence of AIHA, PRCA or HPS, and his clinical course has been uneventful.