High-dose ganciclovir in HHV-6 encephalitis of an immunocompetent child.
Encephalitis and other neurologic complications, including acute necrotizing encephalopathy, are associated with human herpesvirus-6 infection. Antiviral treatment against human herpesvirus-6 infection is indicated only for immunocompromised patients. We describe a 15-month-old immunocompetent child with severe human herpesvirus-6-induced encephalitis. The primary infection was characterized by human herpesvirus-6 DNA in cerebrospinal fluid and serum, the presence of serum human herpesvirus-6 immunoglobulin M antibodies, and a rise in serum human herpesvirus-6 immunoglobulin G antibodies. Magnetic resonance imaging demonstrated multiple, partly symmetric, necrotic lesions in the pons, medulla oblongata, thalamus, external capsules, and occipital subcortical and cortical areas. High-dose ganciclovir (18 mg/kg/day) was used as antiviral treatment, without side effects. A pharmacokinetic analysis of ganciclovir was performed. The initial recovery from severe disease was good. At 3-year follow-up, neurologic sequelae included epilepsy and ataxia. This case suggests that treatment with ganciclovir should be considered in human herpesvirus-6 central nervous system infections because the neurologic sequelae may otherwise be severe. Controlled, prospective, clinical trials are warranted, to analyze the pharmacokinetics of ganciclovir in infants.
Olli-Lähdesmäki
Tuire
T
Department of Pediatrics and Pediatric Neurology, Turku University Hospital, Turku, Finland. tuiolla@utu.fi
Haataja
Leena
L
Parkkola
Riitta
R
Waris
Matti
M
Bleyzac
Nathalie
N
Ruuskanen
Olli
O
D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018792:Encephalitis, Viral / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage* / Q000627:therapeutic use; D015654:Herpesvirus 6, Human; D006801:Humans; D007223:Infant; D019349:Roseolovirus Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D016896:Treatment Outcome
D000998:Antiviral Agents; D015774:Ganciclovir