Human herpesvirus-6B active infection associated with relapsing bilateral anterior optic neuritis.
OBJECTIVE
Human herpesvirus-6 (HHV-6) is the causative agent of exanthem subitum. Both HHV-6 variants, A and B, have been associated with central nervous system (CNS) diseases, suggesting a wide neuropathogenic potential. We describe a case of recurrent bilateral anterior optic neuritis with HHV-6 active infection associated with clinical relapses.


METHODS
A 23-year old woman presented with progressive visual impairment, bilateral papillitis and painful ocular movements. Nested polymerase chain reaction (PCR) for DNA viruses, HHV-6 variant specific real time quantitative PCR, serological analysis and retrotranscription PCR (RT-PCR) for HHV-6 mRNA transcripts were performed. Nested PCR in PBMC and CSF samples was negative for all viruses but positive for HHV-6 DNA, subtyped as HHV-6B. The disease had a relapsing/remitting course. During relapses PBMC samples remained positive for HHV-6 DNA, and HHV-6 active infection was confirmed by the presence of anti-HHV-6 IgM and of HHV-6 U27 mRNA transcript. High viremia levels and relapses were overlapping. After the last relapse, the patient was successfully treated with gancyclovir.


CONCLUSIONS
The case reported here suggests a possible association of HHV-6 in bilateral optic neuritis. HHV-6 could be monitored when bilateral optic neuritis is identified, in order to establish an appropriate antiviral therapy.
Moschettini
D
D
Department of Molecular Biology, Microbiology and Virology Section, University of Siena, Policlinico Le Scotte, Tower 5, Level 2, Viale Bracci 1, 53100 Siena, Italy.
Franceschini
R
R
Vaccaro
N M
NM
Cermelli
C
C
Pezzini
F
F
Balestrieri
M
M
Cerase
A
A
Bartalini
S
S
Ulivelli
M
M
Tosi
G M
GM
Donati
D
D
D000328:Adult; D004279:DNA, Viral / Q000032:analysis / Q000235:genetics; D005260:Female; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D009902:Optic Neuritis / Q000175:diagnosis / Q000821:virology*; D020133:Reverse Transcriptase Polymerase Chain Reaction
D004279:DNA, Viral