Human polyomavirus BK (BKV) and JC (JCV) infections were examined in persons infected with human immunodeficiency virus type 1 (HIV-1). High frequencies of BKV (24%) and JCV viruria (16%) were detected by polymerase chain reaction (PCR). BKV viruria was not found in an immunocompetent control group, in contrast to a frequency of JCV viruria of 20%. The degree of HIV-induced immunodeficiency did not influence the prevalence of BKV viruria, in contrast to cytomegalovirus viruria, suggesting BKV reactivation is an early manifestation in HIV infection as well as a temporal sequence of opportunistic infections. BKV DNA but not JCV DNA was detected in peripheral blood mononuclear cells (PBMC) in 2 of 42 subjects by a sensitive nested PCR. Sequencing of viral noncoding control regions (NCCRs) revealed predominantly archetypal and TU type BKV NCCRs but only archetypal JCV NCCRs. A new, naturally occurring BKV NCCR variant was detected in 1 urine specimen and 2 PBMC samples, indicating a stable and biologically significant rearrangement. Serum levels of BKV antibodies do not seem to be diagnostically useful in HIV-infected persons.

The frequent use of fomepizole in this young patient was not associated with any detectable side effects; neither on clinical examination and lab screening, nor on the later autopsy. Regarding the sequelae from the repetitive EG-poisoning episodes, her kidney function seemed to normalize after each overdose. She was treated with buffer and antidote without hemodialysis 81 times without complications, supporting the safety of this approach in selected cases.

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The rapid increase of potassium levels in blood upon lowering of pH (approximately 0.5 mmol per 0.1 decline in pH) can be exploited therapeutically as in our case. An anorectic patient developing hypokalemia should be treated in hospital.

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