American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2016 9 20() doi 10.1111/ajt.14057
We report a lung transplant recipient who developed BK polyoma virus (BKPyV) DNAemia and BKPyV nephropathy. With careful management of his immunosuppression he achieved significant reduction in BKPyV DNAemia and stabilization of his kidney function. He later developed a high-grade bladder cancer and shortly thereafter he experienced a major upsurge in the level of BKPyV DNAemia that coincided with the discovery of hepatic metastasis. Retrospectively, the bladder cancer and the hepatic secondary tumor stained uniformly for SV40 large T antigen (SV40 LTAg), and the BKPyV DNA sequences identified in plasma corresponded to BKPyV DNA within hepatic tissue indicating that the spike in BKPyV load was likely derived from the circulating tumor cells or cell free tumor DNA following metastases of a BKV-associated cancer. To the best of our knowledge this is the first description of a surge in BKPyV load in a patient with controlled BKPyVN that heralded the appearance of a metastatic urothelial malignancy. This report discusses the literature on BKPyV-associated malignancies and the possibility that unexplained increases in BKPyV DNAemia may be a biomarker for metastatic BKPyV-related urothelial cancer. This article is protected by copyright. All rights reserved.