BK Polyomavirus Hemorrhagic Cystitis following Allogeneic Bone Marrow Transplant with Haploidentical Related Donor: Case Reports from Two Patients
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چکیده
Hemorrhagic cystitis is a common complication in allogeneic bone marrow transplant recipients [1]. The association of BK virus cystitis and allogeneic bone marrow transplant was first described two decades ago [2]. The incidence of hemorrhagic cystitis in allogeneic bone marrow transplant patients is reported up to 70%, while BK viruria after allogeneic bone marrow transplant is detected in 50 to 100% of the patients [1-6]. Hemorrhagic cystitis is a cause of significant morbidity following allogeneic bone marrow transplant. Many factors have been implicated in the etiology including the toxic effects of the chemotherapeutic drugs and viral infections. The most common viruses associated with hemorrhagic cystitis in both children and adults are BK virus, cytomegalovirus (CMV) and adenovirus [1,3,7,8). Among immunocompromised patients, only two strains of polyomaviruses have been proven to cause disease. Polyomavirus hominis 1 (BK virus) causes cystitis, nephritis and polyomavirus hominis 2 (JC virus) causes multifocal leukoencephalopathy (PML). The prevalence of BK virus increases with intense immunosuppressive therapy and it is probably the most common cause of hemorrhagic cystitis in allogeneic hematopoietic stem cell transplant (allo HSCT) recipients [9]. The mainstay of treatment in these patient is reducing the dose of immunosuppressive therapy, bladder irrigation, anti-viral agents and monitoring of BK virus in urine and blood. Up till now only few reports have attributed the role of BK virus in the pathogenesis of hemorrhagic cystitis after allo -HSCT [2,9-11]. Here we describe two cases of BK virus hemorrhagic cystitis following allogeneic stem cell transplant from a haploidentical match related donor. In the cases discussed below, we used myeloablative-conditioning regimen along with post transplant cyclophosphamide. This resulted in intense immunosuppression leading to reactivation of BK virus. We found that cytology was useful in the diagnosis of BK virus infection in urine. Supportive care along with Leflunomide treatment resulted in improvement of symptoms, however the infection resulted in prolonged hospital stay and significant morbidity.
منابع مشابه
Hemorrhagic cystitis after allogeneic hematopoietic stem cell transplants is the complex result of BK virus infection, preparative regimen intensity and donor type.
BACKGROUND Hemorrhagic cystitis is a common cause of morbidity after allogeneic stem cell transplantation, frequently associated with BK virus infection. We hypothesized that patients with positive BK viruria before unrelated or mismatched related donor allogeneic hematopoietic stem cell transplantation have a higher incidence of hemorrhagic cystitis. DESIGN AND METHODS To test this hypothesi...
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BACKGROUND Hemorrhagic cystitis (HC) is a major complication of high-dose cyclophosphamide therapy used in the preparative regimen for allogeneic or autologous bone marrow transplantation. Several viruses (adenovirus, cytomegalovirus and polyomavirus BK) have also been implicated in the etiology of HC. No one established method of treatment is as yet available. MATERIALS AND METHODS HC develo...
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Hemorrhagic cystitis (HC) is characterized by painful hematuria attributed to inflammation of the bladder urothelium. The incidence is 12.2%. The clinical characteristics of HC range from microscopic hematuria to severe bleeding with clot retention and even renal failure. It is an important cause of occasional morbidity and mortality in patients undergoing bone marrow transplant. Several predis...
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TO THE EDITOR: The BK virus (BKV) is a human polyomavirus of the Papovaviridae family and causes clinical disease mainly in immunocompromised hosts such as patients infected with human immunodeficiency virus or transplant recipients [1]. Only a few cases of BKV encephalitis have been reported in hematopoietic stem cell (HSC) transplant recipients, with the majority of cases presenting with conc...
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BK viras is a human polyoma viras. It is acquired in early childhood and remains life-long latent in the genitourinary system. BK virus replication is more common in receiving immunosuppressive therapy receiving patients and transplant patients. BK virus could cause hemorrhagic cystitis in patients with allogeneic stem cell transplantation. Hemorrhagic cystitis is a serious complication of hema...
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