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A5664 - Hyperbaric Oxygen Therapy (HBOT) of an Adolescent Stem Cell Transplantation (SCT) Recipient with Hemorrhagic Cystitis, and BK Virus: A Rare Case Study in the United States
Author Block: D. Lopez1, L. Tan2, A. Alismail1; 1Cardiopulmonary Sciences, Loma Linda University, Loma Linda, CA, United States, 2Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University, Loma Linda, CA, United States.
Introduction: HBOT has been shown to be an effective treatment in fibroblast proliferation, capillary angiogenesis and decreasing edemaespecially in hemorrhagic cystitis. Based on recent and initial findings regarding the use of HBOT in patients undergoing SCT, and their concomitant post-transplant morbidities, a consult was requested resulting in this rare adjunctive treatment approach. Among the possible morbidities associated with SCT is hemorrhagic cystitis (HC). The incidence of HC can be as high as 50% of SCT procedures, and represents a noteworthy morbidity risk to these patients. BK virus (BKV) commonly presents as a polyomavirus latent opportunistic infection, a major contributing factor to the onset of HC of up to 50% in this population. It is also estimated that the BK-virus is present in up to 80% of the general population, expressed as opportunistic in the immunosuppressed and immunocompromised patients. Late onset HC is also attributed to the BK- virus in this population of immunosuppressed, immunocompromised individuals. Case: The patient is a 15 y/o male with Chronic Myelogenous Leukemia (CML) status post Haploindetical Stem Cell Transplant (HSCT). Following transplantation, the patient developed HC secondary to BK- Virus. Based on poor medication compliance for HC due to BKV HBOT was perscribed. A total of 20 HBOTs were administered for 90 minutes at 2 ATA. HBOT was discontinued based on the resolution of HC signs and symptoms. Discussion: A frequent complication of hematopoietic SCT is HC, resulting in diffuse inflammation and vascular injury of the bladder mucosa. Late-onset HC is a dangerous and often life-threatening condition that it is frequently associated with reactivation of various viruses such as adenovirus, polyoma and BKV. To further assist in healing, HBOT can be used to treat damaged tissue from hypoxic injury, and wound healing through stimulation of angiogenesis and fibroblast proliferation. HBOT have been reported to have a cure rate of 78.5% in pediatric patients with BKV associated SCT. Savva-Bordalo et al. reported similar findings with clinical resolution of hematuria in 94% of the 16 patients they treated with HBOT. To date, there continues to be growing evidence of HBOT being an adjunctive therapy for patients with BK-virus associated HC after SCT. Although prospective, randomized controlled trials are needed to establish efficacy and safety. To our knowledge, our case is the first successful report in the United States utilizing HBOT in the treatment of BK-virus associated HC after SCT.