Abstract
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 hematopoietic stem cell transplantation. Hemorrhagic cystitis could cause morbidity and long stay in the hospital. Diagnosis is more frequently determined by the presence of BK virus DNA detected with quantitative or real-time PCR testing in serum or plasma and less often in urine. The reduction of immunosuppression is effective in the treatment of BK virus infection. There are also several agents with anti-BK virus activity. Cidofovir is an active agent against a variety of DNA viruses including poliomyoma viruses and it is a cytosine nucleotide analogue. Intravenous immunoglobulin IgG (IVIG) also includes antibodies against BK and JC (John Cunningham) viruses. Hereby, we report three cases of hemorrhagic cystitis. Hemorrhagic cystitis developed in all these three cases of allogeneic stem cell transplantation due to acute myeloid leukemia (AML). BK virus were detected as the cause of hemorrhagic cystitis in these patients. Irrigation of the bladder was performed. Then levofloxacin 1 x750 mg intravenous and IVIG 0.5 gr/kg were started. But the hematuria did not decreased. In the first case, treatment with leflunomide was started, but patient died due to refractory AML and severe graft-versus-host disease after 4th day of leflunamide and levofloxacin treatments. Cidofovir treatment and the reduction of immunosuppressive treatment decreased the BK virus load and resulted symptomatic improvement in the second case. Initiation of cidofovir was planned in the third case. Administration of cidofovir together with the reduction of immunosuppression in the treatment of hemorrhagic cystitis associated with BK virus in allogeneic stem cell transplant recipients could be a good option.
Highlights
Conflict of interest: the authors declare no potential conflict of interest.and Stem Cell Transplantation Clinic, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, TurkeyBK virus is a human polyoma virus that is acquired in childhood
Hemorrhagic cystitis could e cause morbidity and long stay in the hospital
We present three allogeneic stem cell transplanted patients with hemorrhagic cystitis associated BK virus
Summary
Conflict of interest: the authors declare no potential conflict of interest. and Stem Cell Transplantation Clinic, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey. A 64-year-old male patient with AML started, but patient died due to refractory cell (WBC): 1930/μL (neutrophil: 450/μL), secondary to myelofibrosis was admitted to AML and severe graft-versus-host disease platelet: 52,000/μL, creatinine: 1.21 mg/dL, the Bone Marrow Transplantation Service after 4th day of leflunamide and lev- blood urea nitrogen (BUN): 18 mg/dL, uric (BMTS) for ASCT. It could cause to morbidity and long term hospital stay.[5] In a study conducted by Arthur et al BK virus was detected in 53 hematopoietic stem cell transplant recipients.[6] ASCT were performed in three days. Hemorrhagic cystitis developed after 3th month of transplantation in the first case and hemorrhagic cystitis developed after approximately 1 months reduction of immunosuppressive treatment caused to improve symptoms and findings They caused to decrease in the BK virus load.
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