title: Diffuse gastrointestinal bleeding and BK polyomavirus replication in a pediatric allogeneic haematopoietic stem cell transplant patient.
abstract: Patients undergoing haematopoietic stem cell transplantation (HSCT) are at high risk of severe gastrointestinal bleeding caused by infections, graft versus host disease, and disturbances in haemostasis. BK polyomavirus (BKPyV) is known to cause hemorrhagic cystitis, but there is also evidence of BKV shedding in stool and its association with gastrointestinal disease. We report putative association of BKPyV replication with high plasma viral loads in a pediatric HSCT patient developing hemorrhagic cystitis and severe gastrointestinal bleeding necessitating intensive care. The observation was based on chart review and analysis of BKPyV DNA loads in plasma and urine as well as retrospective BKPyV-specific IgM and IgG measurements in weekly samples until three months post-transplant. The gastrointestinal bleeding was observed after a >100-fold increase in the plasma BKPyV loads and the start of hemorrhagic cystitis. The BKPyV-specific antibody response indicated past infection prior to transplantation, but increasing IgG titers were seen following BKPyV replication. The gastrointestinal biopsies were taken at a late stage of the episode and were no longer informative of BK polyomavirus involvement. In conclusion, gastrointestinal complications with bleeding are a significant problem after allogeneic HSCT to which viral infections including BKPyV may contribute.
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Finland. Electronic address: minna.koskenvuo@utu.fi.
authors.forename: M
authors.initials: M
authors.lastname: Koskenvuo
authors.affiliation: Department of Virology, Helsinki University Hospital (HUSLAB) and University of Helsinki, Helsinki, Finland.
authors.forename: I
authors.initials: I
authors.lastname: Lautenschlager
authors.affiliation: Transplantation & Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Kardas
authors.affiliation: Department of Virology, Helsinki University Hospital (HUSLAB) and University of Helsinki, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Auvinen
authors.affiliation: Department of Virology, Helsinki University Hospital (HUSLAB) and University of Helsinki, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Mannonen
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Huttunen
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Taskinen
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Vettenranta
authors.affiliation: Transplantation & Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland; Infectious Diseases &Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: H H
authors.initials: HH
authors.lastname: Hirsch
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus / Q000235:genetics; D002648:Child; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D027601:Polyomavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy
chemical_list: D000998:Antiviral Agents
keywords: BK virus; Bleeding; Gastrointestinal; HSCT; Hemorrhagic cystitis; Polyoma