Variant B human herpesvirus-6 associated febrile dermatosis with thrombocytopenia and encephalopathy in a liver transplant recipient.
Human herpesvirus 6 (HHV-6) is a recently discovered virus the pathogenicity of which in solid organ transplant recipients has not been defined. We describe a unique febrile syndrome due to disseminated invasive variant B HHV-6 infection in a liver transplant recipient with evidence of direct tissue invasion by the virus. Acute febrile illness characterized by life-threatening thrombocytopenia, progressive encephalopathy and skin rash developed in association with invasive HHV-6 infection in a liver transplant recipient. HHV-6 was isolated from the patient's peripheral blood in cell culture; variant B HHV-6 DNA was detected in the patient's peripheral blood mononuclear cells (PBMC) at a concentration greater than 1000 virus genomes per 10(6) PBMC. A bone marrow biopsy was also positive for HHV-6, documenting direct tissue invasion. Intravenous ganciclovir for three weeks led to a prompt clinical response. Although larger studies are warranted, our case suggests that HHV-6 should be considered in the diagnostic evaluation of patients with fever, cytopenia, and encephalopathy, particularly since HHV-6 is susceptible to ganciclovir and foscarnet.
Singh
N
N
Department of Medicine, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15240, USA.
Carrigan
D R
DR
Gayowski
T
T
Singh
J
J
Marino
I R
IR
D000328:Adult; D001483:Base Sequence; D017931:DNA Primers / Q000737:chemistry; D004279:DNA, Viral / Q000032:analysis; D003872:Dermatitis / Q000209:etiology*; D005334:Fever / Q000209:etiology; D006566:Herpesviridae Infections / Q000175:diagnosis* / Q000503:physiopathology; D015654:Herpesvirus 6, Human / Q000472:pathogenicity*; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation / Q000276:immunology*; D008969:Molecular Sequence Data; D013921:Thrombocytopenia / Q000209:etiology; D019896:alpha 1-Antitrypsin Deficiency
D017931:DNA Primers; D004279:DNA, Viral