Hyperbaric Oxygen Therapy of an Adolescent Stem Cell Transplantation Recipient with Hemorrhagic Cystitis and BK Virus

Case Reports in Pulmonology
01 Jan, 2021 ,

David López et.al. presented a case of a 15-year-old male with chronic myelogenous leukemia status posthaploidentical stem cell transport with BK virus in the United States to be treated by Hyperbaric oxygen therapy.  The findings of this case support and shows that there is growing evidence for the use of Hyperbaric oxygen therapy as adjunctive therapy for patients with BK virus associated with HC after stem cell transplantation.

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This is a case of a 15-year-old male with chronic myelogenous leukemia (CML) status posthaploidentical stem cell transplant (HSCT). In addition, the patient had an infectious disease history of strep viridans, fungal prophylaxis, CMV viremia, and adenovirus. BK viremia was initially asymptomatic with the patient developing hemorrhagic cystitis soon after the procedure.

The patient was started on a standard treatment of cidofovir 1 mg/kg/dose with probenecid and leflunomide (loading dose of 100 mg daily × 3 days, then 40 mg daily). In addition, the patient was also placed on levofloxacin for synergistic treatment. The platelet count on admission was 49 bil/L, red blood cell count 3.06 tril/L hemoglobin 9.8 g/dl, hematocrit 28%, and RDW 23.2%. Also, the BK virus was greater than 2 million BK on admission. The admission diagnosis was poor medication compliance-induced HC due to BK in an immunocompromised state associated with SCT, hypomagnesemia, and pancytopenia.

Despite the standard of care therapy for HC after stem cell transplantation (cidofovir, leflunomide, and levofloxacin, continuous bladder irrigation), the patient's HC continued to worsen: increasing BK virus flow counts, hematuria, and no improvement of RBC (2.70 tril/L), Hgb (8.1 g/dL), Hct (22.4%), and RDW (15.1%).

HBOT was available and prescribed to the patient. On day 1, the initial order of HBOT, using a monochamber, was 2 ATA for 90 minutes per treatment with an assessment and evaluation of the patient's condition at treatment 10. Treatment was prescribed daily Monday through Friday. At day 10, treatment 10, the patient was evaluated indicating the treatment was tolerated. In addition, some improvement in the hematuria from the nephrostomy tubes was noted (BK virus count 19460 copies/mL down from 2 million); therefore, additional 10 treatments were prescribed to the patient.

On day 20, following treatment 20, an evaluation shows the BK virus count trending down to 2362 copies/mL with improvement in the hematuria. Therefore, additional 10 treatments were added to support the continuing down trend of the BK virus count and decreasing hematuria, along with the patient showing significant overall improvement. At day 30, HBOT was discontinued after treatment 30 based on the resolution of HC signs and symptoms (hematuria and normal or absent BK virus count).