An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy.

We report a lung transplant recipient who developed BK polyoma virus (BKPyV) DNAemia and BKPyV nephropathy. With careful management of his immunosuppression he achieved significant reduction in BKPyV DNAemia and stabilization of his kidney function. He later developed a high-grade bladder cancer and shortly thereafter he experienced a major upsurge in the level of BKPyV DNAemia that coincided with the discovery of hepatic metastasis. Retrospectively, the bladder cancer and the hepatic secondary tumor stained uniformly for SV40 large T antigen, and the BKPyV DNA sequences identified in plasma corresponded to BKPyV DNA within hepatic tissue, indicating that the spike in BKPyV load was likely derived from the circulating tumor cells or cell-free tumor DNA following metastases of a BKV-associated cancer. To the best of our knowledge, this is the first description of a surge in BKPyV load in a patient with controlled BKPyVN that heralded the appearance of a metastatic urothelial malignancy. This report discusses the literature on BKPyV-associated malignancies and the possibility that unexplained increases in BKPyV DNAemia may be a biomarker for metastatic BKPyV-related urothelial cancer.

Survey of alcohol and drug misuse in spinal cord injured veterans.

Although the spinal cord injured population is considered by many to be especially vulnerable to alcohol and drug misuse, there is little factual information regarding the prevalence of alcohol and drug misuse among this group. To survey alcohol and drug misuse in a large population of spinal cord injured veterans, a 61-item questionnaire was mailed to 2000 randomly selected members of the Paralyzed Veterans of America organization. Of 1083 questionnaires returned, 992 were usable. The results were analyzed with regard to sociodemographic data, level of injury, type of accident, current medication use and the use of alcohol and recreational drugs. Statistical analyses were performed using chi-square tests. The majority of respondents indicated the regular use of alcohol prior to age 21 and before the spinal injury (70.1%). Conversely, the majority who acknowledged the use of recreational drugs reported the use began after the injury (75%). In contrast to the notion that the spinal cord injured individual is at high risk for alcohol and drug misuse, this study indicates alcohol and drug use is far less than in the general population.