Effect of high dose IVIG for treatment on polyoma virus nepropathy occurred after TCMR treatment

초록

Introduction: Introduction Reactivation of BK polyoma virus causes a destructive virus allograft nephropathy (BKVAN) with graft loss in 46%. Treatment options are limited to reduced immunosuppression and largely ineffective antiviral agents. Thus, we report a case that a TCMR patient treated by steroid therapy had BK viremia, and was not responsive to reduction of immunosuppressant and leflunomide treatment, but recovered after IVIG treatment. case presentation The patient had peritoneal dialysis for 3 years, and showed elevation of serum creatinine level (1.2->2.3) and reduction of urine output at 2 months after renal transplantation, which led to suspicion as TCMR, so that steroid pulse therapy (solumedrol 250mg q12hr) was performed for 3 days. Real-time quantitative PCR from urine and serum identified over 106 copies of BKV. Kidney biopsy found polyoma virus nepropathy (BK virus positive) and C4d negative. Under the impression of BK virus infection, we suspended administration of Tacrobell 2.75mg bid, MMF (Myrept 500mg bid), and Tacrobell 2mg bid and MMF that were being taken, and administered ciprofloxacin and leflunomide. However, BK Viremia showed no improvement even after 6 months’ treatment, so that the patient was administered with 12 g of IVIG per dose 5 times. Thereafter, BK level decreased below 103 shown by PCR, and 1.8 of creatinine level was maintained. The patient is currently being followed up. Conclusion: BK treatment method has not been clearly established, and pros and cons of IVIG treatment are controversial. Meanwhile, this case demonstrated that treatment using high dose IVIG should be helpful for treatment of BK virus. This case can be a foundation that RCT and prospective study using IVIG should be conducted in the future.