Status:
Ready to upload
Record number:
1733
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Rare
Time to detection:
9 months
Alerting signals, symptoms, evidence of occurrence:
Kidney recipient 27 yo from deceased donor complaining of confusion and headache 9 months after transplantation. JC polyomavirus detected in CSF at time of symptoms presentation and retrospectively 5 months before symptoms. Brain CT was normal and MRI with no parenchymal brain lesions, but transient cerebral venous sinus thrombosis was present. ECG changes compatible with raised intra cranial pressure or a diffuse encephalopathy. CSF showed an increased protein concentration of 92 mg/dL, low glucose (48.6 mg/dL), WBC of 1.3 x 100/μL (mononuclear cells, 99%; polymorphs, 1%) and red blood cell count of 9 x 100/μL. Progressive decline in neurological function necessitated immunotherapy cessation and allograft removal, which led to decreasing serum viral loads and resolution of neurological symptoms. JC polyomavirus (JCPyV) was detected in the graft by quantitative polymerase chain reaction and immunohistochemical staining. CNS symptoms improved on dialysis.
Demonstration of imputability or root cause:
A JCPyV VP1 enzyme-linked immunosorbent assay was used to measure patient and donor antibody titers.The patient was JCPyV naive pre-transplant, but showed high antibody titers during the neurological symptoms, with the IgM decrease paralleling the viral load after graft removal. Contralateral kidney recipient was seronegative pre-transplant, had a negative PCR in blood but paper does not mention seroconversion. Genetic analysis: identical archetype JCPyV genomes amplified from different body sites suggests an unchecked primary infection seeded by a JCPyV-positive graft.
Imputability grade:
2 Probable
Groups audience:
Keywords:
References:
Reference attachment:
Suggest references:
A Difficult Decision: Atypical JC Polyomavirus Encephalopathy in a Kidney Transplant Recipient. Bialasiewicz et al. Transplantation 2016;00: 00–00
Note:
Add reference and JC polyomavirus in the infection taxonomy (EP)
Expert comments for publication:
Authors describe a primary infection with archetype JCPyV associated with CNS symptoms, suggesting archetype noncoding control region's (NCCR) capacity for activity within glial cells, although at a lower level to that of rearranged NCCR variants. Neurological symptoms were not consistent with dural sinus thrombosis which, in conjunction with the worsening symptoms despite the radiological resolution of the thrombus, point to an alternate etiology.