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Kirincich J, Basic-Jukic N, Radic J, Lovric-Kujundzic S, Kastelan Z. A Kidney Transplant Recipient With Fulminant Progressive Multifocal Leukoencephalopathy-Immune Reconstitution Inflammatory Syndrome: A Rare Clinical Outcome and Review of the Literature. EXP CLIN TRANSPLANT 2019; 18:242-246. [PMID: 31580233 DOI: 10.6002/ect.2018.0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Progressive multifocal leukoencephalopathy is a devastating disease affecting the central nervous system that may be seen in immunocompromised patients. We present a case of a kidney transplant recipient who received tacrolimus, mycophenolic acid, and prednisone and who developed motor deficits, altered cognition, and speech abnormalities, which culminated in a coma. The diagnosis was made by detecting John Cunningham polyomavirus DNA with polymerase chain reaction and observing characteristic findings on magnetic resonance imaging. Soon after immunosuppressive therapy was withdrawn, the patient's clinical status deteriorated due to immune reconstitution inflammatory syndrome, and prednisone was administered. Unfortunately, the patient died about 9 months after onset of symptoms. This case serves to illustrate the fulminant progression of progressive multifocal leukoencephalopathy and the possible complications that may arise when treating it.
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Affiliation(s)
- Jason Kirincich
- >From the Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
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Ramanan P, Timmerman EA, Fidler ME, Amer H, Pritt BS, Schwab DA, Batterman HJ, Binnicker MJ. A kidney transplant recipient with renal medullary viral cytopathic changes. Transpl Infect Dis 2017; 19. [PMID: 27925350 DOI: 10.1111/tid.12646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/11/2016] [Accepted: 09/09/2016] [Indexed: 01/17/2023]
Abstract
We present a case of JC polyomavirus (JCV)-associated nephropathy (PyVAN) in an asymptomatic deceased-donor kidney transplant recipient. Despite the presence of viral cytopathic effect in the kidney biopsy and positive BK polyomavirus (BKV) in situ hybridization (ISH), BKV real-time polymerase chain reaction (PCR) results of plasma and urine were negative. JCV ISH was performed and was found to be positive. JCV real-time PCR on urine, plasma, and the kidney biopsy tissue was positive. Reduction in immunosuppression resulted in resolution of JCV viremia. This case highlights that JC-PyVAN is a distinct clinical entity and is likely to have a better clinical outcome than BK-PyVAN. Concurrent infection with BKV and JCV may occur, but may be difficult to confirm due to the potential for cross-reactivity between BKV and JCV ISH stains.
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Affiliation(s)
- Poornima Ramanan
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Timmerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Mary E Fidler
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Hatem Amer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Bobbi S Pritt
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN, USA
| | - Dale A Schwab
- Focus Diagnostics Inc. Reference Laboratory, A Quest Subsidiary, San Juan Capistrano, CA, USA
| | - Hollis J Batterman
- Focus Diagnostics Inc. Reference Laboratory, A Quest Subsidiary, San Juan Capistrano, CA, USA
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