BK Virus Pneumonia with CMV Colitis in a Kidney Transplant Recipient: Successful Treatment with Non-Cidofovir Based Therapy

BK virus (BKV) pneumonia is a rare entity especially seen in immunosuppressed patients, for which cidofovir is the used treatment option. We describe a case of a young female patient who presented for altered kidney function six months following kidney transplantation for focal segmental glomerulosclerosis and was found to have BKV nephritis. Her in-hospital stay was complicated by BKV pneumonia requiring mechanical ventilation, in addition to CMV colitis. She was treated with leflunomide/ciprofloxacin and ganciclovir for her pneumonia and colitis, respectively. The patient improved clinically except that her kidney function deteriorated. Leflunomide/ciprofloxacin combination may constitute an effective and safe alternative to cidofovir for the treatment of BKV pneumonia, in particular when cidofovir is not available. J Microbiol Infect Dis 2021; 11(1):36-41.

___

  • 1. Reploeg MD, Storch GA, Clifford DB. Bk virus: a clinical review. Clin Infect Dis an Off Publ Infect Dis Soc Am. 2001;33(2):191-202.
  • 2. Park SB, Kwak JH, Lee KT, et al. Polyoma Virus-Associated Nephropathy and Concurrent Cytomegalovirus Infection in the Kidney Transplant Recipients. Transplant Proc. 2006; 38(7):2059-2061.
  • 3. Cordero E, Casasola C, Ecarma R, Danguilan R. Cytomegalovirus disease in kidney transplant recipients: incidence, clinical profile, and risk factors. Transplant Proc. 2012;44(3):694-700.
  • 4. Hariharan S. BK virus nephritis after renal transplantation. Kidney Int. 2006;69(4):655-662.
  • 5. Yapa HMN, McLornan DP, Raj K, et al. Pneumonitis post-haematopoeitic stem cell transplant - cytopathology clinches diagnosis. J Clin Virol Off Publ Pan Am Soc Clin Virol. 2012;55(3):278-281.
  • 6. Yoshimura A, Tsuji T, Kawaji Y, Hirakawa Y, Uchiyama H, Hiraoka N. BK virus pneumonia following stem cell transplantation against diffuse large B-cell lymphoma. Respirol case reports. 2018;6(7): e00348.
  • 7. Hirsch HH, Knowles W, Dickenmann M, et al. Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients. N Engl J Med. 2002;347(7):488-496.
  • 8. Galan A, Rauch CA, Otis CN. Fatal BK polyoma viral pneumonia associated with immunosuppression. Hum Pathol. 2005;36(9):1031-1034.
  • 9. Blazquez-Navarro A, Dang-Heine C, Wittenbrink N, et al. BKV, CMV, and EBV Interactions and their Effect on Graft Function One Year Post-Renal Transplantation: Results from a Large Multi-Centre Study. EBioMedicine. 2018; 34:113-121.
  • 10. Sandler ES, Aquino VM, Goss-Shohet E, Hinrichs S, Krisher K. BK papova virus pneumonia following hematopoietic stem cell transplantation. Bone Marrow Transplant. 1997;20(2):163-165.
  • 11. Toyoda M, Puliyanda DP, Amet N, et al. Co-infection of polyomavirus-BK and cytomegalovirus in renal transplant recipients. Transplantation. 2005;80(2):198-205.
  • 12. Akazawa Y, Terada Y, Yamane T, et al. Fatal BK virus pneumonia following stem cell transplantation. Transpl Infect Dis. 2012;14(6):E142-6.
  • 13. Zaman RA, Ettenger RB, Cheam H, Malekzadeh MH, Tsai EW. A novel treatment regimen for BK viremia. Transplantation. 2014;97(11):1166-1171.