Polyoma BK virus: an emerging opportunistic infectious agent of the human central nervous system

Silva, Rodrigo Lopes da

doi:10.1590/s1413-86702011000300017

Cited by 2 publications

(1 citation statement)

References 37 publications

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“…More recently, BKV has been described as an emerging pathogen in the central nervous system 3 . However, its true pathogenicity is complicated by its known central nervous system latency in asymptomatic immunocompetent and immunocompromised individuals 4 .…”

Section: Discussionmentioning

confidence: 99%

BK virus‐associated progressive multifocal leukoencephalopathy

Daveson

Ong

Bowden

et al. 2013

Medical Journal of Australia

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Section: Discussionmentioning

confidence: 99%

BK virus‐associated progressive multifocal leukoencephalopathy

Daveson

Ong

Bowden

et al. 2013

Medical Journal of Australia

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BK polyomavirus associated progressive multifocal leukoencephalopathy in a person living with HIV

O’Kelly

Keane

Devitt

et al. 2021

Brain, Behavior, & Immunity - Health

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Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the white matter central nervous system occurring in immunocompromised patients particularly those with T cell deficiency such as in HIV, haematological and solid organ malignancies and those taking immunomodulatory medications. PML is caused by JC virus however in rare cases BK virus has been isolated in the cerebral spinal fluid of patients presenting with PML. In this case we describe a 49 year old man who presented to the emergency department with a 2 week history of progressive right sided weakness and dysarthria. His background history included HIV diagnosed in 2005, he had not engaged with care in the past 2 years and had not been taking anti-retroviral therapy (ART). Other past medical history included untreated hepatitis C. His CD4 count was 90 (11%) cells/mm 3 on admission and his HIV viral load VL) was 141,000 copies/ml. Magnetic resonance imaging(MRI) showed a hypointense lesion on T1, hyperintense on T2 and FLAIR without diffusion restriction and without mass effect. A lumbar puncture was performed which confirmed JC virus was positive (PCR <50 copies/ml) and also revealed BK virus was positive (PCR 46,511 copies/ml). The patient was commenced on tenofovir alafenamide fumarate/emtricitabine/darunavir/cobicistat in combination with dolutegravir 50mg twice daily. On day 40 post commencement of ART the patient was readmitted with worsening of his right arm weakness and dysarthria. A repeat MRI was performed which showed the hyperdense lesion on T2 and FLAIR appeared slightly larger with some slight enhancement with gadolinium contrast but no other features suggesting PML immune reconstitution inflammatory syndrome (IRIS). The CD4 count had increased to 141(17%) and HIV VL had decreased to 85 copies/ml. A clinical diagnosis of PML IRIS was made and the patient was commenced on prednisolone 30mg BD which lead to an initial improvement in symptoms. Interestingly in this case, both JC virus and BK virus were detected in the CSF of this patient with the level of JC virus being too low to quantify. BK virus was not detectable on peripheral serum sampling suggesting that BK virus is replicating in the CNS independent of other body sites. There have been 5 case reports in the literature of BK virus as the cause of PML. Testing for BK virus should be considered in patients presenting with signs and symptoms of PML and encephalitis particularly when no other cause is found.

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Polyoma BK virus: an emerging opportunistic infectious agent of the human central nervous system

Cited by 2 publications

References 37 publications

BK virus‐associated progressive multifocal leukoencephalopathy

BK virus‐associated progressive multifocal leukoencephalopathy

BK polyomavirus associated progressive multifocal leukoencephalopathy in a person living with HIV

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