BK Virus Encephalitis in HIV-Infected Patients: Case Report and Review

Antoniolli, Luciana Pavan; Borges, Rafael; Goldani, Luciano Zubaran

doi:10.1155/2017/4307468

Cited by 8 publications

(5 citation statements)

References 23 publications

(18 reference statements)

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“…Regarding PLWH, 12 were identified in a review of published cases by Antoniolli et al. including a case described by the authors ( Antoniolli et al., 2017 ). One difficulty that arises with possible cases of BK virus associated neurological pathology is discerning if BK virus is the true cause of a disease process.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Given the similarities between these viruses it does appear that in some immunocompromised patients BK virus can acquire neurotropic properties and has been found in the CSF and brain tissue of patients with encephalitis, meningitis, meningoencephalitis, retinitis and even PML ( Antoniolli et al., 2017 ; Silva, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

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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“…These histopathological findings are more similar to the lesions observed in the two cows than are classical PML lesions. In addition, BKPyV rarely induces meningoencephalitis, affecting mainly ventricular and meningeal surfaces, in immunosuppressed patients [ 37 ]. The SV40 virus can also induce meningoencephalitis; on experimental infection, monkeys that were positive for simian-human immunodeficiency virus developed a PML-like phenotype [ 38 ] or productive neuronal infection [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Bovine Polyomavirus 2 is a Probable Cause of Non-Suppurative Encephalitis in Cattle

2020

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Tissues from two cows with neurological signs that were admitted to the Vetsuisse Faculty under suspicion of rabies and bovine spongiform encephalopathy (BSE), respectively, were further analyzed for this case report. After histopathological examination and exclusion of BSE and rabies, the animals were diagnosed with etiologically unresolved disseminated non-suppurative encephalitis. Using next-generation sequencing, we detected the full genome of bovine polyomavirus 2 (BoPyV2) in brain samples from both animals. This virus has been identified in beef samples in three independent studies conducted in the United States and Germany, but has not been linked to any disease. Analysis of the two new BoPyV2 genome sequences revealed close phylogenetic relationships to one another and to BoPyV2 isolates detected in beef samples. In situ hybridization demonstrated the presence of viral nucleic acid in all investigated brain areas and in areas with signs of inflammation in both animals. Thus, we provide the first evidence that BoPyV2 is a probable cause of non-suppurative encephalitis in cattle, and encourage further molecular and serological testing to elucidate the disease’s epidemiology, as well as experimental transmission studies to prove causality between the infection and disease.

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“…Apart from hemorrhagic cystitis and chronic interstitial tubulopathy among transplant patients (especially kidneys and bone marrow transplants), other complications can occur among patients with other kinds of immunosuppression, in particular in patients with AIDS where cases of meningoencephalitis, with 70% mortality, have been reported [13,14]; cases of retinitis have also been published [15]. Cases of hemorrhagic cystitis among HIV patients appear to be quite rare [16][17][18], even if possibly underestimated.…”

Section: Hemorrhagic Cystitis From Bk Virus In a Patient With Aidsmentioning

confidence: 99%

Hemorrhagic cystitis from BK virus in a patient with AIDS

Hassold

Baltes

Martin

et al. 2021

Aids

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BK Virus Encephalitis in HIV-Infected Patients: Case Report and Review

Cited by 8 publications

References 23 publications

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

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

Bovine Polyomavirus 2 is a Probable Cause of Non-Suppurative Encephalitis in Cattle

Hemorrhagic cystitis from BK virus in a patient with AIDS

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