title: BK virus nephropathy after allogeneic stem cell transplantation: a case report and literature review.
abstract: Polyomaviruses are increasingly recognized as important human pathogens. Among those, BK virus has been identified as the main cause of polyomavirus-associated nephropathy (PVAN), a major cause of renal allograft failure. PVAN has also been well described in the setting of non-renal solid organ transplantation. The reports of PVAN after hematopoietic stem cell transplantation (HCT) are surprisingly very few. Here, we describe a patient with treatment-related myelodysplastic syndrome who received an unrelated donor HCT after ablative conditioning and in vivo T cell depletion with alemtuzumab. He developed a biopsy-proven BK nephropathy, which contributed to his renal failure. Leflunomide as well as cidofovir were given at different times, both in combination with intravenous immunoglobulin. Both treatments were effective in reducing the BK viral load, the cystitis symptoms and both stabilized but did not really improved the renal function. The patient was still dialysis-dependent when he died from Pseudomonas sepsis 13 months after HCT. A critical review of the literature and the treatment modalities for post-HCT PVAN are provided.
authors.affiliation: Markey Cancer Center, University of Kentucky, Lexington, Kentucky 40536, USA. ljleka2@uky.edu
authors.forename: Lazaros J
authors.initials: LJ
authors.lastname: Lekakis
authors.forename: Valentina
authors.initials: V
authors.lastname: Macrinici
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Baraboutis
authors.forename: Bonnie
authors.initials: B
authors.lastname: Mitchell
authors.forename: Dianna S
authors.initials: DS
authors.lastname: Howard
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus / Q000472:pathogenicity*; D003556:Cystitis / Q000209:etiology / Q000821:virology; D003586:Cytomegalovirus Infections / Q000150:complications; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006530:Hepatorenal Syndrome / Q000209:etiology; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008224:Lymphoma, Follicular / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000601:surgery; D009395:Nephritis, Interstitial / Q000209:etiology* / Q000821:virology; D027601:Polyomavirus Infections / Q000150:complications* / Q000635:transmission; D011183:Postoperative Complications; D012086:Reoperation; D016559:Tacrolimus / Q000009:adverse effects; D019172:Transplantation Conditioning / Q000009:adverse effects; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous / Q000009:adverse effects*
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016559:Tacrolimus