BK VIREMIA EXACERBATION WITH COVID-19 INFECTION IN A KIDNEY
TRANSPLANT RECIPIENT
Şerife Bektaş1, Mehmet Eren Yuksel1, Çağlayan Merve Ayaz2, Seval İzdeş1
1Ankara Yildirim Beyazit University School of Medicine, Intensive Care Unit
2Ankara City Hospital, Department of Infectious Diseases
INTRODUCTION: Immunocompromised patients with Coronavirus-19 disease (COVID-19) who have previously undergone kidney transplantation should be carefully examined for BK virus, which is a DNA virus from polyoma-virus family and is localized in renal tubular epithelial cells after primary infection.
CASE: A 61-year-old male patient complaining of chest pain was admitted to the emergency department. High serum troponin level and COVID-19 PCR positivity were detected. Since non-ST-MI could not be ruled out, the patient was admitted to the intensive care unit for further follow-up and treatment. The thorax-CT revealed ground-glass appearance with peripherally localized patchy interlobular septal thickening in both lungs. The patient admitted that he underwent bilateral nephrectomy for renal cell carcinoma and renal transplantation in 2013, having been treated with oral mycophenolate mofetil 180 mg 2x1, everolimus 0.75 mg 2x1, prednisolone 5 mg 1x1. His serum creatinine level in January 2021 was 1.97 mg/dL (reference range: 0.7-1.3 mg/dL), whereas his serum creatinine level rose up to 4.73 mg/dl and the glomerular filtration rate decreased to 15% in April 2021. Urine BK virus PCR examination (Artus QS-RG Q Real-Time PCR) revealed 93.206 copies/mL (linear range in plasma and urine: 50-9.26x10.000.000 copies/ml, analytical sensitivity: 26.7 copies/ml). Moreover, blood BK virus PCR revealed 70 copies/mL.
CONCLUSION: 80% of the general population is infected with BK virus. However, activation of the BK virus may cause interstitial nephritis and failure of the allograft in immunosuppressive patients who have had a kidney transplant. Reactivation of BK virus is associated with a weaker cytotoxic CD8+ T cell response in immunocompromised patients. T cells, especially CD8+ T cells, are also decreased in COVID-19 patients. Therefore, BK virus infection should be suspected in renal transplant patients infected with COVID-19 when serum creatinine level gradually increases.
Keywords : BK virus, COVID-19, Renal, Transplantation
May 2021
- Conference: 23rd International Intensive Care E-Symposium , Turkish Society of Intensive Care
