Clinical and endoscopic features of nonsteroidal anti-inflammatory drug-induced colonic ulcerations

OBJECTIVE: Clinical and endoscopic features of nonsteroidal anti-inflammatory drug (NSAID)-induced colonic ulcerations have not been fully investigated. METHODS: During a 3-yr period from April 1996 to March 1999, 6076 subjects underwent total colonoscopy at our institutions. Among them, the diagnosis of NSAID-induced colonic ulceration was made by their clinical and colonoscopic findings. All patients diagnosed as having this disease underwent upper endoscopy and follow-up colonoscopy. Clinical features, serial changes in colonoscopic findings, and upper GI lesions were analyzed. RESULTS: Among the subjects, 14 patients were diagnosed as having NSAID-induced ulcerations. Seven patients were complicated by renal failure. Three patients had gastric ulcers concurrently. Eleven patients had colonic lesions in the ileocecal region. In 13 of 14 patients, initial colonoscopy demonstrated sharply demarcated, semilunar or circumferential ulcers without stricture formation. After discontinuance of NSAIDs, improvement of the ulcers without stricture or inflammatory polyps could be confirmed 3-10 wk later. In one patient with diaphragm-like stricture, follow-up colonoscopy performed 2 yr later demonstrated resolution of circumferential ulcer. CONCLUSIONS: NSAID-induced colonic ulceration may occur more frequently than previously recognized. Frank ulcerations, rather than stricture formation, seem to be the typical colonoscopic signs of NSAID-induced colonic ulceration.     

BK virus DNA: cleavage map and sequence analysis.

A detailed physical map of the BK virus (MM strain) genome has been constructed with respect to the cleavage sites of 11 different restriction enzymes. The enzymes cut BKV(MM) DNA at 61 specific sites whose locations have been determined. Preliminary nucleotide sequence was carried out in the region from 0.70-0.75 map positions on BKV(MM) DNA. An 80% homology was found at 0.714-0.744 map positions on BKV(MM) DNA with 0.722-0.752 map positions on simian virus 40 DNA. This region of simian virus 40 DNA codes for the synthesis of the leader sequence of late mRNA.     

BK virus DNA sequence: extent of homology with simian virus 40 DNA.

The primary nucleotide sequence of three regions of BK virus (BKV) variant (MM) DNA has been determined. The region between map positions 0.715 and 0.900 includes the initiation points and partial coding sequences of the putative VP2 and VP3 proteins of BKV(MM), the amino acid sequences of which show over 80% homology with those of VP2 and VP3 of simian virus 40. The sequence of a potential leader protein X, 66 amino acids long for BKV(MM) and 62 long for simian virus 40, is also deduced. The regions between 0.595 and 0.398 and 0.310 and 0.175 include the coding sequence for the entire small t antigen and most of the large T antigen of BKV(MM). The DNA sequence within these regions comprises over 50% of the complete BKV(MM) genome and shows a 70% sequence homology with the corresponding regions of simian virus 40 DNA. This high degree of homology is at variance with the reported homology values of 11--20% estimated by hybridization measurements of heteroduplex analyses. Possible explanations for the discrepancy are discussed.     

BK virus infection in patients with AIDS

Antibodies to the human papovavirus BK (BKV) were determined in a group of 25 homo- and bisexual males with AIDS, 24 men with AIDS-related complex (ARC) and 18 healthy male homosexual controls from Copenhagen. The AIDS patients had a significantly lower prevalence and level of anti-BKV antibodies tested by IgG-ELISA, hemagglutination inhibition and neutralization tests than the ARC patients. About half of the anti-BKV antibody positive AIDS patients demonstrated primary infections or reactivations but without specific IgM production. The titers were low compared to primary infections in children. At least 2 of the patients lost their serological markers in the late phase of the disease. It is therefore possible that the low prevalence of BKV infection in AIDS patients is caused by loss of serological markers even if the level of total IgG is normal or increased.     

Fatal BK virus pneumonia following stem cell transplantation

We report the case of a 39‐year‐old male patient who died of severe BK virus (BKV) pneumonia 168 days after hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia. After suffering from BKV‐associated late‐onset hemorrhagic cystitis (HC) with long‐term sustained BKV viremia, he died of rapidly progressive pneumonia. On autopsy, numerous viral intranuclear inclusions were seen in his lungs and bladder. An immunohistochemical examination of his lungs was positive for simian virus 40. Based on these pathological results and the high sustained BKV viral load in his blood, we reached a diagnosis of BKV pneumonia. Viral infection can occasionally become life threatening among HSCT recipients. It is widely known that BKV can cause late‐onset HC, but BKV‐associated pneumonia is rare. Because of its rapid progression and poor prognosis, it is difficult to make an antemortem diagnosis of BKV pneumonia. A treatment strategy for BKV pneumonia also needs to be formulated. Similar to other viral pathogens, BKV can cause pneumonia and the clinician should therefore be aware of it in immunocompromised patients.     

Homology and relationship between the genomes of papovaviruses, BK virus and simian virus 40.

A number of hybridization techniques have been used to assess the homology between the genomes of BK virus (BKV) and simian virus 40 (SV40). A noncontiguous set of homologous sequences has been localized primarily within the late region of the SV40 genome, and these sequences presumably account for the cross-reaction between V-antigens of the two viruses. The reason for the relatively strong crossreaction between SV40 and BKV T-antigens is still unclear. The sequence homology and similarity in genomic organization suggest a close relationship between these papovaviruses.     

Cytomegalovirus-associated perianal ulcerations in AIDS.

We report two patients with the acquired immune deficiency syndrome and cytomegalovirus associated perianal ulcerations. Both complained of chronic, painful, nonhealing ulcers that required surgical intervention for diagnosis and palliation. One patient developed diffuse cytomegalovirus infection and both had poor response to gancyclovir therapy. We review the pertinent clinical and pathologic findings of this serious manifestation of cytomegalovirus infection.     

Occurrence of BK virus DNA in DNA obtained from certain human tumors.

DNA sequences from BK virus have been detected by measurements of reassociation kinetics in DNA preparations isolated from five of 12 human tumor tissues and three of four human tumor cell lines; no DNA sequences from BK virus could be found using the same assay in DNA samples obtained from nontumor tissues removed from various patients. Whether or not this association is trivial, indicative of infection by BK virus, or correlative with the tumor state must await the testing of additional samples of normal and tumor tissues as well as a definition of the physical state of the genome of BK virus.     

Early regions of JC virus and BK virus induce distinct and tissue-specific tumors in transgenic mice.

JC virus and BK virus are ubiquitous human viruses that share sequence and structural homology with simian virus 40. To characterize tissue-specific expression of these viruses and to establish model systems for the study of human viral-induced disease, transgenic mice containing early regions of each of the viruses were produced. The viral sequences induced tumors in a distinct and tissue-specific manner that was similar to their tissue tropism in humans. Ten JC virus-containing founder mice were produced, of which 5 survived to maturity. Four of them developed adrenal neuroblastomas, which metastasized to several other tissues. JC virus tumor-antigen RNA was detected at high levels in the tumor tissues and at low levels in the normal tissues of these mice. One of the three BK virus-containing mice was abnormally shaped and died at 2 weeks of age. The other two BK virus-containing mice developed primary hepatocellular carcinomas and renal tumors and died at 8-10 months of age. BK virus tumor-antigen RNA was expressed in tumor tissues of both mice. Since each of the viruses retained the general tissue tropism that it exhibits in humans, these data suggest that transgenic mice harboring human viruses will be useful as animal models for viral-induced diseases.