BK virus is a known cause of
renal failure in kidney transplant recipients, but there is little data regarding its effect on native kidneys in heart transplant patients. Here, we describe the case of a child who underwent
heart transplantation and was later diagnosed with BK virus with multiorgan involvement. This patient was diagnosed with
dilated cardiomyopathy at 4 months of age and underwent
heart transplantation at the age of 5 years. Before
transplantation, the patient suffered from
cardiac arrest and fungal
pyelonephritis. The patient had no evidence of
azotemia. Ten months after
transplantation, the patient was diagnosed with
diffuse large B-cell lymphoma associated with
Epstein-Barr virus infection. She underwent
chemotherapy, and later developed
azotemia and BK
viremia. The findings on renal biopsy were compatible with BK nephropathy. After the biopsy, she was treated with intravenous
cidofovir,
immunoglobulins, and oral
leflunomide. The
tacrolimus dose was also reduced. However, the patient's renal function continued to worsen. She developed
end-stage renal disease and started
peritoneal dialysis. After experiencing a seizure, the patient was found to have positive BK virus polymerase chain reaction in the cerebrospinal fluid. Brain magnetic resonance image revealed a new white matter lesion in the splenium. On immunohistochemistry, there was SV40-positive staining in gastric and heart biopsy specimens. Therefore, BK virus enteropathy and cardiac involvement were suspected. This case suggests that BK virus
infection can lead to systemic involvement and can be fatal.
.