Diffuse gastrointestinal bleeding and BK polyomavirus replication in a pediatric allogeneic haematopoietic stem cell transplant patient

Koskenvuo, Minna; Lautenschlager, I; Kardas, Piotr; Auvinen, Eeva; Mannonen, Laura; Huttunen, Pasi; Taskinen, Mervi; Vettenranta, Kim; Hirsch, Hans H.

doi:10.1016/j.jcv.2014.11.016

Cited by 9 publications

(5 citation statements)

References 15 publications

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“…It is unclear whether the neurologic symptoms were secondary to the reactivated CNS BK virus or disseminated BK virus from the blood. Dissemination of BK virus to the GI tract causing diffuse bleeding in a child and to the lungs leading to fatal pneumonia in an adult have been described in stem cell recipients 6,7 . Our patient did not have clinical evidence of GI or pulmonary involvement.…”

Section: Discussionmentioning

confidence: 48%

“…This includes patients with HSCT, non‐renal SOT, HIV, hematological malignancies, and other immunodeficiency conditions 4,5 . Besides native nephropathy, other organ system involvement has also been described in such patients, including GI and respiratory tract 6,7 . Here we describe a 10‐year‐old boy with allogeneic HSCT who developed BK virus encephalitis along with BKVN of native kidneys, requiring chronic dialysis and subsequently a renal transplantation.…”

Section: Introductionmentioning

confidence: 95%

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BK virus encephalitis and end‐stage renal disease in a child with hematopoietic stem cell transplantation

Bush

Johns

Betty

et al. 2020

Pediatric Transplantation

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BK virus encephalitis after HSCT is uncommon. Several reports of native kidney BKVN in patients with HSCT, hematologic malignancies, human immunodeficiency virus infection, and non‐renal solid organ transplantation have been described. However, an uncommon combination of BK encephalitis and ESRD of native kidneys secondary to BK virus in a child with HSCT has not been described. We report a 10‐year‐old boy who presented with a gradually rising serum creatinine during treatment for severe autoimmune hemolytic anemia, which he developed 9 months after receiving an allogeneic HSCT for aplastic anemia. There was no proteinuria or hematuria present. Serum BK virus load was 5 × 106 copies/mL. A renal biopsy showed evidence of BKVN. He developed fever, seizures, and confusion, and the (CSF) showed significant presence of the BK virus (1 × 106 copies/mL) along with biochemical evidence of viral encephalitis. Cerebrospinal fluid cultures were negative. Despite significant clinical symptoms and presence of BK virus in CSF, the magnetic resonance brain imaging findings were minimal. With reduction of immunosuppression, there was resolution of BK encephalitis but BKVN remained resistant to multiple anti‐BK virus agents, including leflunomide and cidofovir. He eventually became dialysis‐dependent and, 6 years later, received a renal transplant from his mother. This case illustrates that BK virus in severely immunocompromised HSCT recipient may lead to BK encephalitis and BKVN of native kidneys, even without hemorrhagic cystitis, leading to ESRD. Knowledge of such is important for appropriate timely evaluation and management.

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Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 95%

BK virus encephalitis and end‐stage renal disease in a child with hematopoietic stem cell transplantation

Bush

Johns

Betty

et al. 2020

Pediatric Transplantation

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“…Although, as mentioned previously, most of the literature focuses on specific causes of immunosuppression, chiefly kidney transplant recipients, there are some reports of BKV disease among patients undergoing hematopoietic stem cell transplants, 5 and patients with HIV infection. 6 Patients with autoimmune diseases, such as SLE, by themselves immunosuppressant, have been found to have higher rates of BKV viremia and viruria.…”

Section: Discussionmentioning

confidence: 99%

Systemic BK Virus Infection in a Pediatric Patient With Severe Combined Immunodeficiency

et al. 2020

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Human BK virus (BKV) infection is known to occur mostly during childhood with the establishment of latent infection with no tissue damage or clinical manifestations. However, conditions causing immunosuppression can lead to increased virus replication and tissue damage. Although the tissues most commonly involved are the kidneys, bladder, ureters and, to some extent, brain tissue, there are some reports that suggest that BKV may cause multisystemic infections. In this case, a 12-month-old child was seen to suffer from multiple gastrointestinal infections. This prompted a search for immunodeficiencies, which revealed the presence of severe combined immunodeficiency. The child was eventually hospitalized and continued showing recurrent bouts of gastroenteritis as well as lower respiratory infection. After multiple antibiotic courses, he developed acute kidney injury, a hemophagocytic syndrome, and eventually respiratory failure, which led to his death a year later. Autopsy findings revealed the presence of a disseminated BKV infection involving the kidneys, ureters, leptomeninges, and pancreas. Analysis of the literature failed to show any previous case of BKV pancreatitis. The present case suggests that BKV can damage more tissues than previously reported and may be responsible for systemic infections in immunosuppressed patients.

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“…High frequency of BKV shedding from the gastrointestinal tract in recipients of hematopoietic stem cell transplants has been reported[ 65 ]. Gastrointestinal bleeding associated with bowel lesions putatively caused by BKV infection was reported in a renal transplant recipient[ 281 ] and a hematopoietic stem cell transplant recipient[ 282 ]. Interestigly, high rates of BK viruria in patients with inflammatory bowel disease have been documented[ 283 ].…”

Section: Clinical Manifestations Of Bkv Infection Other Than Nephropamentioning

confidence: 99%

BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection

Vigil

Konstantinov

Barry

et al. 2016

WJT

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Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy (BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research.

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Diffuse gastrointestinal bleeding and BK polyomavirus replication in a pediatric allogeneic haematopoietic stem cell transplant patient

Cited by 9 publications

References 15 publications

BK virus encephalitis and end‐stage renal disease in a child with hematopoietic stem cell transplantation

BK virus encephalitis and end‐stage renal disease in a child with hematopoietic stem cell transplantation

Systemic BK Virus Infection in a Pediatric Patient With Severe Combined Immunodeficiency

BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection

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