BK virus encephalitis and end‐stage renal disease in a child with hematopoietic stem cell transplantation

Abstract

BK virus encephalitis after HSCT is uncommon. Several reports of native kidney BKVN in patients with HSCT, hematologic malignancies, human immunodeficiency virus infection, and non‐renal solid organ transplantation have been described. However, an uncommon combination of BK encephalitis and ESRD of native kidneys secondary to BK virus in a child with HSCT has not been described. We report a 10‐year‐old boy who presented with a gradually rising serum creatinine during treatment for severe autoimmune hemolytic anemia, which he developed 9 months after receiving an allogeneic HSCT for aplastic anemia. There was no proteinuria or hematuria present. Serum BK virus load was 5 × 106 copies/mL. A renal biopsy showed evidence of BKVN. He developed fever, seizures, and confusion, and the (CSF) showed significant presence of the BK virus (1 × 106 copies/mL) along with biochemical evidence of viral encephalitis. Cerebrospinal fluid cultures were negative. Despite significant clinical symptoms and presence of BK virus in CSF, the magnetic resonance brain imaging findings were minimal. With reduction of immunosuppression, there was resolution of BK encephalitis but BKVN remained resistant to multiple anti‐BK virus agents, including leflunomide and cidofovir. He eventually became dialysis‐dependent and, 6 years later, received a renal transplant from his mother. This case illustrates that BK virus in severely immunocompromised HSCT recipient may lead to BK encephalitis and BKVN of native kidneys, even without hemorrhagic cystitis, leading to ESRD. Knowledge of such is important for appropriate timely evaluation and management.

Viral meningoencephalitis in pediatric solid organ or hematopoietic cell transplant recipients: a diagnostic and therapeutic approach

“…Rare cases of BKPyV meningoencephalitis have been reported in HCT, renal and heart transplant recipients, including pediatric patients. Symptomatology is similar to that seen in JCPyV-PML ( 87 , 147 , 148 ).…”

“…Timely reduction in immunosuppression, ideally in the setting of limited disease progression, may improve likelihood of survival ( 90 , 148 , 150 ). Antiviral therapies trailed for JCPyV-PML have not prolonged survival or improved neurological outcome.…”

Case report: Autoimmune encephalomyelitis following cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation

“…BK virus infection-induced encephalitis and end-stage renal disease was reported in a child with allo-HSCT. Authors speculated that in immunocompromised patients, viral reactivation may be associated with CNS involvement, leading to encephalitis ( 22 ).…”