BK virus nephropathy in an immunodeficient patient with chronic lymphocytic leukemia

Bij, Akke van der; Betjes, Michiel G. H.; Weening, Jan J.; Cornelissen, Jan J.; Mes, Ted H. M.; Osterhaus, A.D.M.E.; Beersma, Matthias F. C.

doi:10.1016/j.jcv.2009.04.014

Cited by 17 publications

(5 citation statements)

References 15 publications

(19 reference statements)

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“…17,18 As in our patient's case, treatment with IV cidofovir failed both to control the kidney damage and to suppress viral replication, as documented by riding BK DNA levels. 17,18 Several cases of progressive multi-focal leukoencephalopathy (PML) caused by JC virus have been reported in CLL patients treated with fludarabine, 19,20 including one case with JC virus documented in cerebrospinal fluid (CSF) and which progressed despite treatment with cidofovir. 19 As with our patient, a fatal case of polyomavirus pneumonia was documented in a patient with CLL undergoing chemotherapy treatments.…”

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confidence: 60%

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Disseminated Polyomavirus Infection in Chronic Lymphocytic Leukemia (CLL) Following Salvage Chemo-Immunotherapy

2010

Lymphoma and Chronic Lymphocytic Leukemias

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Chemo-immunotherapy treatment for chronic lymphocytic leukemia (CLL) induces high response rates and improves progression free (PFS) and overall survival (OS) as compared to chemotherapy alone. The fludarabine, cyclophosphamide, and rituximab (FCR) regimen is a standard first line and salvage treatment for CLL. However, FCR is associated with significant immunosupression and an increased risk of opportunistic infections (Ols). Here, we report a case of disseminated polyomavirus infection despite standard anti-infective prophylaxis in a relapsed CLL patient in a sustained clinical complete remission (CR) after FCR therapy.

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confidence: 60%

“…The BK virus did not respond to cidofovir and other anti-polyoma virus therapy, as described in several other CLL patients. [17][18][19][20][21] In addition, our patient's CLL was not treatment refractory but rather had been in a sustained clinical complete response over 1 year after completing FCR.…”

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confidence: 99%

Disseminated Polyomavirus Infection in Chronic Lymphocytic Leukemia (CLL) Following Salvage Chemo-Immunotherapy

2010

Lymphoma and Chronic Lymphocytic Leukemias

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“…During maintenance therapy for her leukemia, she developed fever and renal dysfunction associated with high levels of BKV DNA detected in her urine and plasma. Van der Bij et al [10] also reported biopsy-proven PVAN due to BKV in a 57-year-old male with chronic lymphocytic leukemia who developed renal failure after receiving chemotherapy consisted of fludarabine and cyclophosphamide. Therefore, although it is very rare, PVAN can occur not only in HCT recipients but also in immunocompromised patients who had a history of repetitive cycles of chemotherapy.…”

Section: Discussionmentioning

confidence: 95%

Acute renal failure associated with systemic polyoma BK virus activation in a patient with peripheral T-cell lymphoma

et al. 2010

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Renal dysfunction associated with polyoma BK virus (BKV) reactivation usually occurs in the setting of profound immunosuppression related to renal transplantation and hematopoietic stem cell transplantation. However, it has been rarely described as a complication during the course of conventional chemotherapy. Here, we report a case of BKV-associated acute renal failure developed in a patient suffering from refractory peripheral T-cell lymphoma, not otherwise specified. After repetitive cycles of salvage chemotherapy, the patient developed fever and urinary frequency, rapidly followed by anuria that necessitated the emergent institution of hemodialysis. Cytologic examination of the urine revealed the presence of decoy cells and positive immunostaining for polyomavirus simian virus 40 antigen. High levels of BKV were detected in urine and plasma with quantitative real-time polymerase chain reaction, strongly suggesting that his renal failure was due to polyoma virus-associated nephropathy. This rare complication should be kept in mind in case of unexplained renal failure developed in immunodeficient patients undergoing cytotoxic chemotherapy.

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“…The specific viral activation mechanisms remain unknown [47]. The transplant microenvironment may promote viral reactivation, because only sporadic detection of PV in native kidney of patients with other organ transplants or in immunodeficient patients has been reported [52,53]. PVN also commonly occurs in patients with posttransplantation complications, including delayed graft function and acute rejection.…”

Section: Features Of Bknmentioning

confidence: 99%

Viral Infections after Kidney Transplantation: CMV and BK

Večerić-Haler¹,

Kojc²

2019

Perioperative Care for Organ Transplant Recipient

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Opportunistic infections commonly occur during the first 6 months after kidney transplant, including cytomegalovirus (CMV) and polyomaviruses. Viral pathogens such as CMV and polyomaviruses, JC or BK virus (BKV), are able to replicate in the kidney and/or cause systemic disease, and symptomatic infection with these agents can be associated with significant morbidity and mortality in immunocompromised host. While BK virus usually replicates in kidney transplant causing BK virus nephropathy (BKN) with characteristic decoy cells in the urine, CMV infection more often leads to systemic infection involving the gastrointestinal tract (GIT), lungs, or liver and can only sporadically be detected in renal transplant. In both cases, the disease is most often due to reactivation of a latent virus. Prevention and early treatment of posttransplant infection are therefore crucial with kidney transplant recipients. Since BKV viruria and viremia can be seen without renal injury and viral nephropathy, a diagnosis of BKN must be confirmed by renal biopsy. To date, preemptive treatment is the best strategy for CMV infection, while no available standard therapy, except for reduction of immunosuppression, is available for BKV infection.

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BK virus nephropathy in an immunodeficient patient with chronic lymphocytic leukemia

Cited by 17 publications

References 15 publications

Disseminated Polyomavirus Infection in Chronic Lymphocytic Leukemia (CLL) Following Salvage Chemo-Immunotherapy

Disseminated Polyomavirus Infection in Chronic Lymphocytic Leukemia (CLL) Following Salvage Chemo-Immunotherapy

Acute renal failure associated with systemic polyoma BK virus activation in a patient with peripheral T-cell lymphoma

Viral Infections after Kidney Transplantation: CMV and BK

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