title: An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy.
abstract: We report a lung transplant recipient who developed BK polyoma virus (BKPyV) DNAemia and BKPyV nephropathy. With careful management of his immunosuppression he achieved significant reduction in BKPyV DNAemia and stabilization of his kidney function. He later developed a high-grade bladder cancer and shortly thereafter he experienced a major upsurge in the level of BKPyV DNAemia that coincided with the discovery of hepatic metastasis. Retrospectively, the bladder cancer and the hepatic secondary tumor stained uniformly for SV40 large T antigen, and the BKPyV DNA sequences identified in plasma corresponded to BKPyV DNA within hepatic tissue, indicating that the spike in BKPyV load was likely derived from the circulating tumor cells or cell-free tumor DNA following metastases of a BKV-associated cancer. To the best of our knowledge, this is the first description of a surge in BKPyV load in a patient with controlled BKPyVN that heralded the appearance of a metastatic urothelial malignancy. This report discusses the literature on BKPyV-associated malignancies and the possibility that unexplained increases in BKPyV DNAemia may be a biomarker for metastatic BKPyV-related urothelial cancer.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: S
authors.initials: S
authors.lastname: Kuppachi
authors.affiliation: Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: D
authors.initials: D
authors.lastname: Holanda
authors.affiliation: Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: M
authors.initials: M
authors.lastname: Eberlein
authors.affiliation: Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: B
authors.initials: B
authors.lastname: Alexiev
authors.affiliation: Viracor-IBT Laboratories, Lee's Summit, MO.
authors.forename: A J
authors.initials: AJ
authors.lastname: Tyler
authors.affiliation: Viracor-IBT Laboratories, Lee's Summit, MO.
authors.forename: M C
authors.initials: MC
authors.lastname: Wissel
authors.affiliation: Viracor-IBT Laboratories, Lee's Summit, MO.
authors.forename: S B
authors.initials: SB
authors.lastname: Kleiboeker
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.|Division of Internal Medicine, VA Medical Center, Iowa City, IA.|Graduate Program in Molecular and Cellular Biology, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: C P
authors.initials: CP
authors.lastname: Thomas
mesh_terms: D000368:Aged; D001739:BK Virus / Q000472:pathogenicity*; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D027601:Polyomavirus Infections / Q000150:complications* / Q000821:virology; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery* / Q000821:virology; D012307:Risk Factors; D066027:Transplant Recipients; D014412:Tumor Virus Infections / Q000150:complications* / Q000821:virology; D001749:Urinary Bladder Neoplasms / Q000209:etiology* / Q000473:pathology; D019562:Viral Load; D014779:Virus Replication
keywords: cancer/malignancy/neoplasia; clinical research/practice; complication: infectious; disease pathogenesis; immunosuppressant; immunosuppression/immune modulation; infection and infectious agents; kidney transplantation/nephrology; lung transplantation/pulmonology; other; viral: BK/JC/polyoma