Abstract
The BK virus (BKV) is a nonenveloped double-stranded DNA virus of the polyomavirus family that primarily affects immunocompromised people. BKV infects humans at an early age. Initial infections with BKV are mainly asymptomatic and usually remain latent in the brain, peripheral blood, kidneys, and urothelium. Following the primary infection, viruses persist indefinitely as ‘latent’ infections of the kidney and urinary system because the virus is urotheliotropic. Reactivation of the virus infections occurs in individuals with severe immunosuppression states such as kidney and stem cell transplantation and rarely in pregnancy. In this line, BKV has been implicated as a common cause of late-onset haemorrhagic cystitis (HC) in patients who have undergone stem cell transplantation. In contrast, reports of BKV-associated diseases in nontransplant paediatric patients are almost exclusively in patients with human immunodeficiency virus infection. Herein, we report the first case of a child with acute lymphoblastic leukaemia who developed BKV-associated HC without receiving stem cell transplantation while on standard maintenance chemotherapy.
Highlights
Polyomavirus hominis 1, known as BK virus (BKV), infects up to 90% of the general population by adulthood
We report the first case of a boy with acute lymphoblastic leukaemia (ALL) who developed severe haematuria and dysuria due to BKV while he was on standard maintenance chemotherapy without receiving any kind of stem cell transplantation
It seemed to be efficacious because BK viruria detected by polymerase chain reaction (PCR) decreased gradually during the course of the treatment, whether it was due to some degree of immune recovery or actual positive effects of ciprofloxacin needs to be proved in future studies
Summary
Polyomavirus hominis 1, known as BK virus (BKV), infects up to 90% of the general population by adulthood. We report the first case of a boy with acute lymphoblastic leukaemia (ALL) who developed severe haematuria and dysuria due to BKV while he was on standard maintenance chemotherapy without receiving any kind of stem cell transplantation. A five-year-old boy, a case of standard-risk ALL with t(12,21), developed a prolonged course of intermittent fever and productive cough at the end of the second year of maintenance chemotherapy. Investigation for fungal infections, including imaging studies and serum galactomannan assay, was negative, whereas cytomegalovirus pp assay on the sputum was indicated to be positive. He was determined to receive a course of ganciclovir along with the broad spectrum antibiotics including ceftazidime and vancomycin. Urine BK viral load started to decline; as mild degrees of dysuria was persistent for almost two months, the child discharged with oral ciprofloxacin and topical application of lidocaine and a mild steroid cream for symptomatic relief
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