title: Successful ganciclovir therapy in a patient with human herpesvirus-6 encephalitis after unrelated cord blood transplantation: usefulness of longitudinal measurements of viral load in cerebrospinal fluid.
abstract: BACKGROUND
  There have been no reports of human herpesvirus-6 (HHV-6) encephalitis treatment based on both HHV-6 DNA load and the antiviral agent's concentration in the cerebrospinal fluid (CSF).
  
  
  METHODS
  A 20-year-old male with a hematological malignancy developed HHV-6 encephalitis 15 days after unrelated cord blood transplantation (UCBT). He had fever, chest pain, memory impairment, and insomnia. His CSF showed no increased cell counts, but the amount of HHV-6 DNA was elevated to 2.0 × 10(6) copies/ìgDNA. Magnetic resonance imaging (MRI) of the head revealed abnormal high-intensity signals in the left limbic system on T2-weighted and diffusion-weighted images. Intravenous administration of ganciclovir (GCV) was initiated at 5 mg/kg every 12 h on day 18, and was continued until day 137. The amount of HHV-6 DNA in the plasma became undetectable on day 25. The HHV-6 load in the CSF decreased to 1.5 × 10(3) copies/ìgDNA on day 32, and reached undetectable levels on day 53. The mean concentration of GCV 1 h after an infusion of 5 mg/kg was 4.12 mg/mL in plasma and 0.7 mg/mL in CSF. The chest pain and insomnia disappeared on days 35 and 47, respectively. Memory defects recovered up to day 85.
  
  
  CONCLUSIONS
  Serial quantification of HHV-6 DNA in CSF may be useful for successful treatment with GCV in post-transplant HHV-6 encephalitis.
authors.affiliation: Department of Pediatrics, Shinshu University School of Medicine, Asahi, 3-1-1, Matsumoto, 390-8621, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hirabayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Nakazawa
authors.forename: Y
authors.initials: Y
authors.lastname: Katsuyama
authors.forename: T
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: S
authors.initials: S
authors.lastname: Saito
authors.forename: K
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: T
authors.initials: T
authors.lastname: Shigemura
authors.forename: K
authors.initials: K
authors.lastname: Sakashita
authors.forename: M
authors.initials: M
authors.lastname: Ichikawa
authors.forename: K
authors.initials: K
authors.lastname: Koike
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D015774:Ganciclovir / Q000493:pharmacokinetics / Q000627:therapeutic use*; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019349:Roseolovirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D015774:Ganciclovir