A case of human herpesvirus 6 encephalitis following pediatric hematopoietic stem cell transplantation: early diagnosis
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CASE REPORT
A case of human herpesvirus 6 encephalitis following pediatric hematopoietic stem cell transplantation: early diagnosis and treatment matters Atsushi Sakamoto1,2 · Masaki Yamada2 · Shin‑ichi Tsujimoto3 · Tomoo Osumi3 · Katsuhiro Arai4 · Daisuke Tomizawa3 · Akira Ishiguro1,3 · Kimikazu Matsumoto3 · Ken‑Ichi Imadome2 · Motohiro Kato3 Received: 29 January 2020 / Revised: 14 April 2020 / Accepted: 29 May 2020 © Japanese Society of Hematology 2020
Abstract Human herpesvirus 6 (HHV-6) is one of the life-threatening infectious complications with significant morbidity and mortality following hematopoietic stem cell transplantation (HSCT). Clinically, the diagnosis of HHV-6 encephalitis can be challenging due to a lack of specific symptoms and definitive diagnostic tests. We report a pediatric HSCT recipient who developed lateonset HHV-6 encephalitis without typical radiographic findings. The routine viral infection monitoring protocol contributed to the prompt diagnosis of HHV-6 encephalitis and early therapeutic intervention. The patient was treated successfully without any neurological complications attributable to HHV-6 encephalitis. HHV-6 encephalitis should remain in the differential diagnosis as an important but treatable disease, even for several months after HSCT and even without radiographic findings. Whenever HHV-6 encephalitis is suspected, antivirals should be initiated promptly to prevent its complications. Keywords Hematopoietic stem cell transplantation · Human herpesvirus 6 · Post-transplant encephalitis · Viral load Abbreviations HHV-6 Human herpesvirus 6 HSCT Hematopoietic stem cell transplantation CNS Central nervous system CSF Cerebrospinal fluid XIAP X-linked inhibitor of apoptosis BMT Bone marrow transplantation GVH Graft-versus-host HVG Host-versus-graft ATG Anti-thymocyte globulin GVHD Graft-versus-host disease HLH Hemophagocytic lymphohistiocytosis CMV Cytomegalovirus * Masaki Yamada yamada‑[email protected] 1
Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
2
Department of Advanced Medicine for Viral Infections, Tokyo, Japan
3
Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan
4
Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
Introduction Human herpesvirus 6 (HHV-6) encephalitis is one of the life-threatening infectious complications with significant morbidity and mortality following hematopoietic stem cell transplantation (HSCT) [1, 2]. To prevent neurological sequelae and death attributable to HHV-6 encephalitis, early diagnosis and prompt initiation of antiviral therapy are crucial. However, it can be challenging to diagnose HHV-6 encephalitis early due to the lack of specific clinical symptoms and definitive diagnostic tests [3, 4]. Although HHV-6 encephalitis is typically diagnosed by the presence of central nervous system (CNS) symptoms, detection of HHV-6 DNA in cerebrospinal fluid (CSF), and abnormal MR
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