title: Case report: severe gastrointestinal inflammation and persistent HHV-6B infection in a paediatric cancer patient.
abstract: Lymphotropic herpesviruses such as human herpesvirus type 6 (HHV-6) have enhanced pathogenicity in some immunocompromised hosts, such as transplant recipients and HIV-infected patients. The clinical relevance of HHV-6 infections in cancer patients undergoing conventional cytotoxic therapy is undetermined, however. Here we report on a 10-month-old boy with an anaplastic astrocytoma, who acquired an HHV-6 variant B infection during chemotherapy. HHV-6B infection caused or triggered severe gastrointestinal inflammation with intractable diarrhoea and failure to thrive over several months. The clinical symptoms were associated with pronounced (CD4) lymphopenia and a marked increase in serum immunoglobulin A levels. After unsuccessful therapy with ganciclovir and foscarnet, combined antiviral and anti-inflammatory treatment with cidofovir and prednisolone controlled the HHV-6 infection and enabled resolution of clinical symptoms.
authors.affiliation: Department of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University of Düsseldorf, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Breddemann
authors.forename: Stephanie
authors.initials: S
authors.lastname: Läer
authors.forename: Klaus G
authors.initials: KG
authors.lastname: Schmidt
authors.forename: Malte
authors.initials: M
authors.lastname: Harjes
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Adam
authors.forename: Amei
authors.initials: A
authors.lastname: Ludwig
authors.forename: Tim
authors.initials: T
authors.lastname: Niehues
authors.forename: Dominik T
authors.initials: DT
authors.lastname: Schneider
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001254:Astrocytoma / Q000188:drug therapy*; D000077404:Cidofovir; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D003967:Diarrhea; D004359:Drug Therapy, Combination; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000503:physiopathology; D015654:Herpesvirus 6, Human / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D007249:Inflammation / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D063065:Organophosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D019349:Roseolovirus Infections / Q000139:chemically induced / Q000150:complications* / Q000821:virology; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D011239:Prednisolone; D000077404:Cidofovir