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BK Haemorrhagic Cystitis — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostBK Haemorrhagic CystitisSCE Infectious Diseases

A 55-year-old man with ANCA-associated vasculitis on Cyclophosphamide develops severe BK polyomavirus haemorrhagic cystitis. BK viral load in urine is >10⁹ copies/mL. He has painful haematuria with clots. What is the management?

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Correct answer: B — Reduce immunosuppression, supportive care (bladder irrigation, pain management); there is no proven specific antiviral for BK cystitis

BK virus haemorrhagic cystitis occurs in immunosuppressed patients (HSCT and solid organ transplant recipients, and patients on Cyclophosphamide). Management is primarily supportive: reduction of immunosuppression (the most important intervention), continuous bladder irrigation for clot evacuation, adequate hydration, pain management, and urology involvement for severe cases. There is no proven specific antiviral — Cidofovir has been used but evidence is limited to case series. Leflunomide and Fluoroquinolones have in-vitro activity but limited clinical data.

Reference: NICE 2024 – BK virus; KDIGO 2024 – BK management