Leucoencéphalopathie multifocale progressive à BK virus chez un patient immunodéprimé par une corticothérapie

doi:10.1016/S0035-3787(05)85040-4

Revue Neurologique

Volume 161, Issue 3, March 2005, Pages 326-330

https://doi.org/10.1016/S0035-3787(05)85040-4 Get rights and content

Résumé

Introduction

Le BK virus a été décrit principalement chez les sujets greffés rénaux, mais des cas de leucoencéphalopathies multifocales progressives ont été rapportés chez des sujes immunodéprimés ou des sujets sains.

Méthode

Nous rapportons le cas d’un patient ayant présenté une leucoencéphalopathie multifocale progressive secondaire au BK virus, favorisée par une cortithérapie au long cours.

Résultats

Dans notre cas, le BK virus a été mis en évidence par PCR dans le liquide céphalo-rachidien. Nous détaillons les cas rapportés dans la littérature avec des tableaux similaires, principalement chez des sujets porteurs du VIH mais aussi chez des sujets immunocompétents.

Conclusion

Bien que le BK virus se manifeste le plus souvent par des atteintes urologiques, il ne faut pas méconnaître sa pathogénie cérébrale et savoir le rechercher spécifiquement, quel que soit le statut immunitaire du patient.

Summary

Introducton

BK virus has been described previously in renal transplant patients, but has also been reported in cases of progressive multifocal leukoencephalopathy.

Method

A case of progressive BK virus multifocal leukoencephalopathy induced by long-term corticosteroid therapy is reported.

Results

In our case, BK virus was detected in cerebrospinal fluid by polymerase chain reaction (PCR). A detailed review of similar cases in the literature showed most of them occured in AIDS patients, but four involved immunocompetent patients.

Conclusion

Though BK virus infection usually leads to urinary tract symptoms in immunologically suppressed patients, it is important to be aware of its neurological manifestations and to recognize BK infections that can occur in immunocompetent patients.

Références (18)

C. Polo et al.
Prevalence and patterns of polyomavirus urinary excretion in immunocompetent adults and children
Clin Microbiol Infect
(2004)
G.L. Stoner et al.
Am J Kidney Dis
(2002)
Behzad-Behbahani A, Klapper PE, Vallely PJ, Cleator GM, Bonington A. (2003a). BK-DNA and JCV-DNA in CSF of patients...
Behzad-Behbahani A, Klapper PE, Vallely PJ, Cleator GM. (2003b). BK virus DNA in CSF of immunocompetent and...
G. Bratt et al.
BK virus as the cause of meningoencephalitis, retinitis and nephritis in a patient with AIDS
AIDS
(1999)
P.M. Chesters et al.
Persistence of DNA sequences of BK virus and JC virus in normal human tissues and in diseased tissues
J Infect Dis
(1983)
P.L. Garavelli et al.
BK virus encephalitis in an HIV-seropositive patient. Preliminary data
Recenti Prog Med
(2002)
B. Hurault de Ligny et al.
Caractères virologiques épidémiologiques et pathogéniques des polyomavirus humains
Presse Med
(2003)
B. Hurault de Ligny et al.
Manifestations cliniques des polyomavirus humains en transplantation rénale
Presse Med
(2003)

There are more references available in the full text version of this article.

Cited by (17)

BK polyomavirus associated progressive multifocal leukoencephalopathy in a person living with HIV
2021, Brain, Behavior, and Immunity - Health
Citation Excerpt :
MRI findings of T2/FLAIR hyperintensity in the parieto-occipital region are typical for PML. Steroids were reduced, the overall outcome is not reported (Cabrejo et al., 2005). A 70-year-old woman with Non-Hodgkins Lymphoma, hypogammaglobulinemia and Sjogren's developed 2 weeks of right sided neglect.
Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the white matter central nervous system occurring in immunocompromised patients particularly those with T cell deficiency such as in HIV, haematological and solid organ malignancies and those taking immunomodulatory medications. PML is caused by JC virus however in rare cases BK virus has been isolated in the cerebral spinal fluid of patients presenting with PML.
In this case we describe a 49 year old man who presented to the emergency department with a 2 week history of progressive right sided weakness and dysarthria. His background history included HIV diagnosed in 2005, he had not engaged with care in the past 2 years and had not been taking anti-retroviral therapy (ART). Other past medical history included untreated hepatitis C. His CD4 count was 90 (11%) cells/mm³ on admission and his HIV viral load VL) was 141,000 copies/ml. Magnetic resonance imaging(MRI) showed a hypointense lesion on T1, hyperintense on T2 and FLAIR without diffusion restriction and without mass effect. A lumbar puncture was performed which confirmed JC virus was positive (PCR <50 copies/ml) and also revealed BK virus was positive (PCR 46,511 copies/ml). The patient was commenced on tenofovir alafenamide fumarate/emtricitabine/darunavir/cobicistat in combination with dolutegravir 50mg twice daily. On day 40 post commencement of ART the patient was readmitted with worsening of his right arm weakness and dysarthria. A repeat MRI was performed which showed the hyperdense lesion on T2 and FLAIR appeared slightly larger with some slight enhancement with gadolinium contrast but no other features suggesting PML immune reconstitution inflammatory syndrome (IRIS). The CD4 count had increased to 141(17%) and HIV VL had decreased to 85 copies/ml. A clinical diagnosis of PML IRIS was made and the patient was commenced on prednisolone 30mg BD which lead to an initial improvement in symptoms.
Interestingly in this case, both JC virus and BK virus were detected in the CSF of this patient with the level of JC virus being too low to quantify. BK virus was not detectable on peripheral serum sampling suggesting that BK virus is replicating in the CNS independent of other body sites. There have been 5 case reports in the literature of BK virus as the cause of PML.
Testing for BK virus should be considered in patients presenting with signs and symptoms of PML and encephalitis particularly when no other cause is found.
Fatal encephalitis due to BK virus in a patient with common variable immunodeficiency: A case report
2013, Journal of Clinical Virology
Encephalitis due to BK virus is a rare condition. Here, we describe a young male patient with common variable immunodeficiency who developed fatal encephalitis due to BK virus. The patient presented initially with ocular symptoms that were followed by behavioral changes and spastic quadriparesis. Diagnosis was made by the compatible clinical findings and detection of viral DNA by polymerase chain reaction in the cerebrospinal fluid. To the best of our knowledge, this is the first report of BK virus encephalitis in a patient with common variable immunodeficiency. We suggest that BK virus should be suspected in cases of encephalitis; particularly in patients with immunodeficiency.
BK-virus infections: A literature review
2012, Medecine et Maladies Infectieuses
Citation Excerpt :
The serological test, also sensible and rather specific, is difficult to analyze. Indeed, virus carriage in a latent stage and crossed immune reactions with other polyomaviruses [13] make it difficult to analyse the IgG level, when reactivations to low viral load alter the level of IgM (which are sometimes absent [13]). Furthermore, some authors have demonstrated that old patients [1], as well as HIV infected patients [14], progressively lose BK-virus specific antibodies.
BK-virus is a very common polyomavirus in the global population, similar to the JC-virus responsible for Progressive Multifocal Leukoencephalopathy. BK-virus infections are an important diagnostic and therapeutic challenge in immuno-compromised patients, including: bone marrow transplant pediatric recipients in whom it may cause hemorrhagic cystitis, renal transplant recipients in whom it may cause interstitial nephropathy leading to graft loss, and in HIV infected patients in whom it may cause some types of encephalitis. Indeed, this poorly documented virus is responsible for infections with various clinical profiles, probably under-diagnosed, but could also be involved in the genesis of some cancers, especially cervix and prostate cancer. We reviewed the latest published data on this virus focusing on its possible pro-oncogenic properties. We also listed the diseases in which it is involved, with an emphasis on rare and insufficiently investigated entities. Finally, we studied the new tools available for diagnosis and treatment, and their importance in current practice.
Le BK-virus est un polyomavirus très répandu dans la population générale, proche du JC-virus responsable de la Leuco-encéphalopathie multifocale progressive. Dans un contexte d’immunodépression, les infections dont il est responsable représentent un problème diagnostique et thérapeutique important chez certains sujets, dont, entre autres : les enfants transplantés de moelle osseuse chez qui il entraîne des cystites hémorragiques, mais aussi les transplantés rénaux où il est responsable de néphropathies interstitielles pouvant conduire à la perte du greffon, et enfin les sujets infectés par le VIH pour lesquels il peut être impliqué dans certaines encéphalites. En effet, ce virus peu connu, est responsable d’infections aux profils cliniques variés, probablement sous diagnostiquées, mais serait aussi impliqué dans la genèse de certains cancers, notamment ceux du col de l’utérus et de la prostate. Nous revenons dans cette revue de littérature sur les connaissances les plus récentes à propos de ce virus et plus particulièrement sur son possible rôle pro-oncogène. Nous établissons aussi un panorama des pathologies dont il est responsable en insistant sur les entités rares insuffisamment recherchées. Enfin, nous étudions les nouveaux moyens diagnostiques et thérapeutiques disponibles, ainsi que leur implication en pratique courante.
Development and validation with clinical samples of internally controlled multiplex real-time PCR for diagnosis of BKV and JCV infection in associated pathologies
2012, Comparative Immunology, Microbiology and Infectious Diseases
Citation Excerpt :
Recently, JCV has been related to PML in multiple sclerosis (MS) patients treated with natalizumab with an incidence of 1 in 1000 [14]. However, BKV has been detected in cerebrospinal fluid (CSF) samples from patients with CNS disease [15–17], including PML [18,19], and JCV can be the aetiological agent of nephropathy [20,21] and HC [22–24]. Consequently, a differential diagnosis of JCV and BKV is necessary.
This article describes the development and validation with clinical samples of an internally controlled multiplex quantitative real-time PCR (QRT-PCR) for human polyomaviruses BK (BKV) and JC (JCV). Blood and urine samples from renal transplant recipients with suspected nephropathy, and cerebrospinal fluid (CSF) specimens from AIDS, natalizumab-treated and HIV-negative patients with suspected progressive multifocal leukoencephalopathy, previously checked for BKV and JCV by conventional PCR, were tested by QRT-PCR. All samples positive by conventional PCR were confirmed by QRT-PCR. Four cases of JCV-associated neurological infection, including all those detected in natalizumab-treated patients, and one case of BKV-related neurological infection were only identified by QRT-PCR. BKV was quantified in the CSF of neurological patients for the first time. Analyses of the Quality Control for Molecular Diagnostics 2010 panel were “highly satisfactory” for BKV and “satisfactory” for JCV. The QRT-PCR is specific and reproducible. It improves the sensitivity of conventional PCR for the diagnosis of BKV and JCV infection in various diseases.
BK virus neurotropism
2011, Journal of Infection and Public Health
Polyoma BK virus: An emerging opportunistic infectious agent of the human central nervous system
2011, Brazilian Journal of Infectious Diseases
BK virus, a double-stranded DNA virus, is a member of the Polyomaviridae family which is known to infect humans. Clinical evidence of disease is mostly encountered in immunosuppressed individuals such as AIDS patients or those who undergo renal or bone marrow transplantation where complications associated with BKV infection manifest commonly as a polyomavirus nephropathy or hemorrhagic cystitis, respectively. Recent evidence suggests that in addition to the JC virus (the other member of the same family known to be strongly neurotropic and responsible for the progressive multifocal leukoencephalopathy), BK virus can infect and cause clinically relevant disease in the human central nervous system. In this mini-review, an analysis of the literature is made. A special focus is given to alert clinicians to the possibility of this association during the differential diagnosis of infections of the central nervous system in the immunocompromised host.

View all citing articles on Scopus

View full text

Brève communicationLeucoencéphalopathie multifocale progressive à BK virus chez un patient immunodéprimé par une corticothérapieProgressive BK virus associated multifocal leukoencephalopathy in an immunocompromised patient treated with corticosteroids

Résumé

Introduction

Méthode

Résultats

Conclusion

Summary

Introducton

Method

Results

Conclusion

Clin Microbiol Infect

Am J Kidney Dis

BK virus as the cause of meningoencephalitis, retinitis and nephritis in a patient with AIDS

AIDS

Persistence of DNA sequences of BK virus and JC virus in normal human tissues and in diseased tissues

J Infect Dis

BK virus encephalitis in an HIV-seropositive patient. Preliminary data

Recenti Prog Med

Caractères virologiques épidémiologiques et pathogéniques des polyomavirus humains

Presse Med

Manifestations cliniques des polyomavirus humains en transplantation rénale

Presse Med

Brève communication
Leucoencéphalopathie multifocale progressive à BK virus chez un patient immunodéprimé par une corticothérapieProgressive BK virus associated multifocal leukoencephalopathy in an immunocompromised patient treated with corticosteroids