[Successful treatment with antiviral agents for human herpesvirus type 6 encephalitis following reduced intensity stem cell transplantation in a patient with myelodysplastic syndrome].
We report here a patient who suffered from PCR-confirmed human herpesvirus type 6 (HHV-6) encephalitis following reduced intensity stem cell transplantation (RIST) from her HLA-matched sibling donor. A 66-year-old woman with MDS-RA underwent RIST from her HLA-matched brother. Engraftment was favorable and grade 2 GVHD (skin and intestine) was observed with good response to 60 mg of prednisolone. On day 162, she developed fever, headache, diplopia, disorientation and abnormal neurological findings including cervical stiffness and nystagmus. An analysis of cerebrospinal fluid (CSF) revealed 80 cells/microl, a glucose level of 50 mg/dl and a protein level of 97 mg/dl on day 162. Although computed tomography (CT) of the brain and electroencephalography (EEG) were nonspecific, HHV-6 was detected in the CSF using polymerase chain reaction (PCR) techniques and the patient was diagnosed as having encephalitis due to local reactivation of HHV-6. Administration of ganciclovir (GCV) and acyclovir (ACV) were started from day 162. Treatment with antiviral agents was effective, with total resolution of her symptoms and the DNA of this virus disappeared from the CSF after 23 days of treatment. This case shows that HHV-6 infection has to be considered in patients with neurological symptoms following stem cell transplantation, and suggests the necessity of PCR for HHV-6 virus from the CSF.
4th Department of Internal Medicine, Sapporo Medical University, School of Medicine, Japan.
Hiroki
H
Chiba
Yasuo
Y
Hirayama
Yasushi
Y
Tsuji
Sumio
S
Sakamaki
Tamotsu
T
Sagawa
Ganji
G
Kuroiwa
Masayoshi
M
Kobune
Takuya
T
Matsunaga
Junji
J
Kato
Yoshiro
Y
Niitsu
D000212:Acyclovir / Q000627:therapeutic use*; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D015654:Herpesvirus 6, Human; D006801:Humans; D009190:Myelodysplastic Syndromes / Q000628:therapy; D019349:Roseolovirus Infections / Q000188:drug therapy* / Q000209:etiology*; D033581:Stem Cell Transplantation / Q000009:adverse effects*
D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir