Case Rep Transplant. 2026 Jul 29;2026:2999849. doi: 10.1155/crit/2999849. eCollection 2026.
ABSTRACT
BACKGROUND: BK polyomavirus (BKPyV) is an opportunistic infection following kidney transplantation due to immunosuppression. It is a recognized cause of tubulitis and graft dysfunction in kidney transplant recipients (KTRs). Management is challenging because clinicians must balance viral control with the risk of acute rejection. This report highlights the importance of individualized therapy in a 63-year-old KTR who developed BK polyomavirus-associated nephropathy (BKPyVAN) after treatment for acute rejection.
CASE REPORT: A 63-year-old man with end-stage renal disease secondary to long-term NSAID use underwent a living-donor kidney transplant at Alzahra Hospital, Isfahan, Iran. He was maintained on tacrolimus, mycophenolate mofetil (MMF), and prednisolone. At 5 months posttransplant, he developed acute cellular rejection treated with antithymocyte globulin (Thymoglobulin). Two months later, BKPyV viremia was detected (23,700 copies/mL). Immunosuppression was modified by switching tacrolimus to cyclosporine and discontinuing MMF. Two doses of intravenous immunoglobulin (IVIG; 2 g/kg total) were administered but discontinued due to fluid overload requiring temporary hemodialysis. Subsequently, the patient developed a large hemorrhagic pericardial effusion (7 × 12 cm) with left ventricular compression, likely attributable to a combination of fluid overload, uremia, and volume shifts during renal replacement therapy, requiring urgent pericardiocentesis with drainage of 550 mL of hemorrhagic fluid. By 10 months posttransplant, renal function stabilized (serum creatinine 2.3 mg/dL) and BKPyV PCR became undetectable.
CONCLUSIONS: This case highlights a rare and life-threatening complication, namely hemorrhagic pericardial effusion, arising during the management of BKPyVAN in a KTR. It underscores the importance of close cardiovascular monitoring, individualized immunosuppressive adjustment, and multidisciplinary care in this complex patient population.
PMID:42529343 | PMC:PMC13417019 | DOI:10.1155/crit/2999849