The evidence is provocative but not definitive; nonetheless, it should serve as a stimulus to further research
In this issue of the Journal, Daveson and colleagues1 describe a case of progressive multifocal leukoencephalopathy (PML) possibly caused by BK virus rather than JC virus. This finding is potentially very significant. The polyomaviruses BK and JC commonly infect humans and remain latent in immunocomptent individuals. Both are associated with clinical disease in the setting of immunosuppression. However, only JC virus has been causally associated with PML; BK virus has been causally associated with nephropathy, ureteric stenosis and cystitis. There have been previous case reports of BK virus causing a meningoencephalitis and PML as detailed by Daveson et al, but the evidence for causality has been tenuous, largely because of the lack of confirmation in tissue. The data provided by Daveson et al are more convincing, although not definitive.
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- 1. Daveson KL, Ong CW, Bowden S, et al. BK virus-associated progressive multifocal leukoencephalopathy. Med J Aust 2013; 198: 216-218.
- 2. Brew BJ, Davies NWS, Cinque P, et al. Progressive multifocal leukoencephalopathy and other forms of JC virus disease. Nat Rev Neurol 2010; 6: 667-679.
- 3. Ferenczy MW, Marshall LJ, Nelson CD, et al. Molecular biology, epidemiology, and pathogenesis of progressive multifocal leukoencephalopathy, the JC virus-induced demyelinating disease of the human brain. Clin Microbiol Rev 2012; 25: 471-506.
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- 5. Dharnidharka VR, Abdulnour HA, Araya CE. The BK virus in renal transplant recipients — review of pathogenesis, diagnosis, and treatment. Pediatr Nephrol 2011; 26: 1763-1774.
- 6. Bloomgren G, Richman S, Hotermans C, et al. Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med 2012; 366: 1870-1880.
- 7. Hirsch HH, Drachenberg CB, Steiger J, Ramos E. Polyomavirus-associated nephropathy in renal transplantation: critical issues of screening and management. Adv Exp Med Biol 2006; 577: 160-173.
- 8. Kidney Disease Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009; 9 Suppl 3: S1-S155.
Bruce Brew has received payment from Biogen Idec for being on the Tysabri (natalizumab) advisory board and for lectures on PML and Tysabri. Eugene Major sits on the Tysabri advisory board for Biogen Idec without receiving payment.