{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:42:40Z","timestamp":1790077360240,"version":"4.0.1"},"reference-count":36,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2013,9,1]],"date-time":"2013-09-01T00:00:00Z","timestamp":1377993600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:p>Objective: To describe a case of BK virus encephalitis with attempted direct antiviral therapy, review the reported cases of BK virus in the central nervous system, and report the novel use of intravenous cimetidine in place of oral probenecid to minimize the toxicities of intravenous cidofovir. Case Summary: A 36-year-old male with acute myelomonocytic leukemia and subsequent myelodysplastic syndrome underwent allogeneic hematopoietic stem cell transplant. His course was complicated by severe graft-versus-host disease involving his skin and gastrointestinal tract. Five weeks after transplantation, he developed fever and confusion. Magnetic resonance imaging was suggestive of limbic encephalitis and cerebrospinal fluid tested positive for BK virus. Therapy with intravenous cidofovir was thought to be indicated. Although probenecid is commonly used to minimize the toxicities of cidofovir, the patient\u2019s severe graft-versus-host disease raised concerns about absorption of oral medications. Based on animal models and pharmacokinetic data, intravenous cimetidine was used in place of oral probenecid. Despite these therapies, the patient\u2019s mental status did not improve. He developed progressive organ system failure, and care was ultimately withdrawn. Discussion: BK virus is increasingly described as a cause of encephalitis. The majority of reported cases have occurred in immunocompromised patients and have generally had a poor outcome. This case describes attempted antiviral therapy using cidofovir, the antiviral agent used most frequently in other syndromes due to BK virus. Intravenous cimetidine is a novel modality used to minimize ocular and renal toxicities frequently seen with cidofovir, and we believe this warrants further investigation. Conclusions: BK virus may be a cause of encephalitis in immunocompromised hosts, and cidofovir represents a possible treatment option. Intravenous cimetidine can be considered to minimize toxicities associated with cidofovir use in patients unable to tolerate or absorb oral probenecid.<\/jats:p>","DOI":"10.1177\/1060028013500646","type":"journal-article","created":{"date-parts":[[2014,7,15]],"date-time":"2014-07-15T13:56:59Z","timestamp":1405432619000},"page":"1229-1233","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":27,"title":["BK Virus Encephalitis"],"prefix":"10.1177","volume":"47","author":[{"given":"Paul","family":"Chittick","sequence":"first","affiliation":[{"name":"Beaumont Health System, Royal Oak, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Wake Forest Baptist Health, Winston-Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A.","family":"Ohl","sequence":"additional","affiliation":[{"name":"Wake Forest Baptist Health, Winston-Salem, NC, USA"},{"name":"Wake Forest University, Winston-Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2013,9,1]]},"reference":[{"key":"bibr1-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000265591.10200.d7"},{"key":"bibr2-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurad.2009.10.001"},{"key":"bibr3-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2010.35"},{"key":"bibr4-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00770-9"},{"key":"bibr5-1060028013500646","first-page":"29","volume":"143","author":"Vallbracht A","year":"1993","journal-title":"Am J Pathol"},{"key":"bibr6-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1996.00550010121025"},{"key":"bibr7-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199906180-00010"},{"key":"bibr8-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200106150-00026"},{"key":"bibr9-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2002.32795"},{"key":"bibr10-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1136\/adc.88.2.174"},{"key":"bibr11-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-003-3078-5"},{"key":"bibr12-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000137106.09925.8B"},{"key":"bibr13-1060028013500646","first-page":"1016","volume":"27","author":"Friedman DP","year":"2006","journal-title":"AJNR Am J Neuroradiol"},{"key":"bibr14-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1186\/1742-6405-4-13"},{"key":"bibr15-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0609.2008.01101.x"},{"key":"bibr16-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2008.198"},{"key":"bibr17-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3062.2010.00581.x"},{"key":"bibr18-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2011.01602.x"},{"key":"bibr19-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70040-5"},{"key":"bibr20-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1016\/0042-6822(92)90167-N"},{"key":"bibr21-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1097\/00042560-199606010-00006"},{"key":"bibr22-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.10370"},{"key":"bibr23-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1099\/vir.0.042143-0"},{"key":"bibr24-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1086\/427291"},{"key":"bibr25-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000181096.14257.c2"},{"key":"bibr26-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1L180"},{"key":"bibr27-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3062.2010.00513.x"},{"key":"bibr28-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkn495"},{"key":"bibr29-1060028013500646","doi-asserted-by":"publisher","DOI":"10.1086\/599829"},{"key":"bibr30-1060028013500646","unstructured":"Vistide (cidofovir injection) [prescribing information]. 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