A case of acute kidney injury due to native kidney BK polyomavirus-associated nephropathy in a human T-lymphotropic virus type 1 carrier.
Adult
Male
Humans
Middle Aged
Kidney Transplantation
/ adverse effects
BK Virus
Human T-lymphotropic virus 1
Kidney
/ pathology
Nephritis, Interstitial
/ pathology
Acute Kidney Injury
/ etiology
Polyomavirus Infections
/ complications
Opportunistic Infections
/ complications
Pneumonia
Kidney Diseases
/ pathology
BK polyomavirus
Human T-lymphotropic virus type 1
Kidney injury
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
31 10 2023
31 10 2023
Historique:
received:
18
04
2023
accepted:
19
10
2023
medline:
2
11
2023
pubmed:
1
11
2023
entrez:
1
11
2023
Statut:
epublish
Résumé
BK polyomavirus-associated nephropathy (BKPyVAN) has become a major cause of kidney dysfunction and graft loss in kidney transplant recipients. On rare occasion, polyomavirus has also been known to affect native kidneys of immunocompromised individuals. Only a small number of opportunistic infections have been reported in the carrier phase of human T-lymphotropic virus type 1 (HTLV-1). This is the first reported case of BKPyVAN in native kidneys of an HTLV-1 carrier. A 61-year-old man was referred to our hospital from a primary care physician for work-up and treatment of pneumonia. He was diagnosed with Pneumocystis pneumonia and identified as a HTLV-1 carrier who had not yet developed adult T-cell leukemia (ATL). The pneumonia was successfully treated with sulfamethoxazole-trimethoprim. He had never been diagnosed with any kind of kidney dysfunction. Laboratory investigations showed a serum creatinine of 5.3 mg/dL, and urinary sediment showed cells with nuclear enlargement and inclusion bodies suggesting viral infection. The urinary Papanicolaou stain showed inclusions in swollen, ground-glass nuclei, typical of "decoy cells". Renal biopsy showed degeneration of tubules with epithelial enlargement, vacuolar degeneration, nuclear inclusion bodies, and detachment from the tubular basement membrane. Tubular nuclei showed positive staining positive for simian virus 40 large-T antigen. Polymerase chain reaction tests for BK polyomavirus DNA of both urine and plasma were positive. These findings confirmed a diagnosis of BKPyVAN. Intravenous immunoglobulin therapy did not improve renal function, necessitating maintenance hemodialysis therapy. BKPyVAN should be considered when acute kidney injury occurs with opportunistic infection. HTLV-1 carriers can develop opportunistic infections even before the onset of ATL.
Sections du résumé
BACKGROUND
BK polyomavirus-associated nephropathy (BKPyVAN) has become a major cause of kidney dysfunction and graft loss in kidney transplant recipients. On rare occasion, polyomavirus has also been known to affect native kidneys of immunocompromised individuals. Only a small number of opportunistic infections have been reported in the carrier phase of human T-lymphotropic virus type 1 (HTLV-1). This is the first reported case of BKPyVAN in native kidneys of an HTLV-1 carrier.
CASE PRESENTATION
A 61-year-old man was referred to our hospital from a primary care physician for work-up and treatment of pneumonia. He was diagnosed with Pneumocystis pneumonia and identified as a HTLV-1 carrier who had not yet developed adult T-cell leukemia (ATL). The pneumonia was successfully treated with sulfamethoxazole-trimethoprim. He had never been diagnosed with any kind of kidney dysfunction. Laboratory investigations showed a serum creatinine of 5.3 mg/dL, and urinary sediment showed cells with nuclear enlargement and inclusion bodies suggesting viral infection. The urinary Papanicolaou stain showed inclusions in swollen, ground-glass nuclei, typical of "decoy cells". Renal biopsy showed degeneration of tubules with epithelial enlargement, vacuolar degeneration, nuclear inclusion bodies, and detachment from the tubular basement membrane. Tubular nuclei showed positive staining positive for simian virus 40 large-T antigen. Polymerase chain reaction tests for BK polyomavirus DNA of both urine and plasma were positive. These findings confirmed a diagnosis of BKPyVAN. Intravenous immunoglobulin therapy did not improve renal function, necessitating maintenance hemodialysis therapy.
CONCLUSIONS
BKPyVAN should be considered when acute kidney injury occurs with opportunistic infection. HTLV-1 carriers can develop opportunistic infections even before the onset of ATL.
Identifiants
pubmed: 37907886
doi: 10.1186/s12882-023-03373-1
pii: 10.1186/s12882-023-03373-1
pmc: PMC10617105
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
323Informations de copyright
© 2023. The Author(s).
Références
Am J Transplant. 2021 Feb;21(2):669-680
pubmed: 32654412
Clin Immunol Immunopathol. 1996 Sep;80(3 Pt 1):325-32
pubmed: 8811055
Am J Health Syst Pharm. 2017 Dec 15;74(24):2037-2045
pubmed: 29222360
Blood. 1981 Sep;58(3):645-7
pubmed: 6455129
Transpl Infect Dis. 2019 Aug;21(4):e13083
pubmed: 30907978
Am J Epidemiol. 2016 Jan 1;183(1):61-9
pubmed: 26667254
Immun Inflamm Dis. 2021 Sep;9(3):777-791
pubmed: 33943020
Intern Med. 1992 Sep;31(9):1132-6
pubmed: 1421724
Acta Med Okayama. 1989 Dec;43(6):317-21
pubmed: 2696327
Lancet. 1971 Jun 19;1(7712):1253-7
pubmed: 4104714
Front Microbiol. 2012 Nov 15;3:388
pubmed: 23162541
Am J Kidney Dis. 1995 Oct;26(4):671-3
pubmed: 7573026
Nephrol Dial Transplant. 2021 Mar 29;36(4):587-593
pubmed: 31891401
Proc Natl Acad Sci U S A. 1984 Apr;81(8):2534-7
pubmed: 6326131
Proc Natl Acad Sci U S A. 1981 Oct;78(10):6476-80
pubmed: 7031654
Genes (Basel). 2022 Jul 21;13(7):
pubmed: 35886073