Encephalitis owing to human herpesvirus-6 after cardiac transplant.
Human herpesvirus-6 (HHV-6), a beta herpesvirus closely related to cytomegalovirus (CMV), infects the majority of the population in childhood. Human herpesvirus-6 can be reactivated in the immunosuppressed patient. After bone marrow and orthotopic liver transplant, it has been linked to various clinical syndromes, including undifferentiated febrile illness, encephalitis, pneumonitis and bone marrow suppression. To date its infectious role after orthotopic heart transplant has not been well documented. We present the case of a 32-year-old cardiac transplant recipient who initially presented 8 weeks after his transplant with high fever and headache. He developed increasing confusion, pulmonary infiltrates and neutropenia. Cytomegalovirus viral loads were negative. Polymerase chain reaction (PCR) of blood and cerebrospinal fluid detected HHV-6 DNA, consistent with HHV-6-related encephalitis, pneumonitis and bone marrow suppression. He was treated with foscarnet with gradual improvement in clinical status. We review the literature on the significance of this virus post cardiac transplant.
Nash
Patrick J
PJ
Department of Cardiovascular Medicine, Cleveland Clinical Foundation, Cleveland, OH, USA.
Avery
Robin K
RK
Tang
W H Wilson
WH
Starling
Randall C
RC
Taege
Alan J
AJ
Yamani
Mohamad H
MH
D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology; D003587:Cytomegalovirus / Q000378:metabolism; D004279:DNA, Viral / Q000032:analysis; D004660:Encephalitis / Q000209:etiology* / Q000473:pathology / Q000821:virology; D017245:Foscarnet / Q000627:therapeutic use; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006566:Herpesviridae Infections / Q000209:etiology*; D015654:Herpesvirus 6, Human / Q000378:metabolism*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007964:Leukocytosis / Q000134:cerebrospinal fluid / Q000378:metabolism; D008297:Male; D009503:Neutropenia / Q000628:therapy; D016133:Polymerase Chain Reaction
D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D017245:Foscarnet