title: Human herpesvirus 6 is associated with status epilepticus and hyponatremia after umbilical cord blood transplantation.
abstract: Status epilepticus after allogeneic hematopoietic cell transplantation (alloHCT) is rare. The authors report a case involving a 65-year-old man with nonconvulsive status epilepticus 34 days after umbilical cord blood transplantion for chronic lymphocytic leukemia. Cerebrospinal fluid and serum were positive for human herpesvirus 6 (HHV6). Magnetic resonance imaging of the brain showed symmetric T2 hyper-intensity bilaterally in the mesial temporal lobes, and T2 hyperintensi-ties and restricted diffusion of bilateral putamina. Despite aggressive anticonvulsive therapy, his seizures only abated with initiation of ganciclovir therapy. The patient completed six weeks of combination antiviral therapy (ganciclovir and foscarnet). His cognitive function gradually improved and, after prolonged rehabilitation, the patient was discharged home with residual intermittent memory loss but otherwise functional. HHV6 should be considered in the differential diagnosis of nonconvulsive status epilepticus after alloHCT, especially in patients with hyponatremia. Empirical antiviral therapy targeting HHV6 should be administered to these patients.
authors.affiliation: Division of Hematology-Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA; ; Department of Hematology-Oncology, Amaral Carvalho Hospital, Jau, Sao Paulo, Brazil.
authors.forename: Fernanda Leite
authors.initials: FL
authors.lastname: de Souza Franceschi
authors.affiliation: Division of Infectious Disease, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA;
authors.forename: Jaime
authors.initials: J
authors.lastname: Green
authors.affiliation: Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA;
authors.forename: Zuzan
authors.initials: Z
authors.lastname: Cayci
authors.affiliation: Division of Hematology-Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA;
authors.forename: Evan
authors.initials: E
authors.lastname: Mariash
authors.affiliation: Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA;
authors.forename: Mustapha
authors.initials: M
authors.lastname: Ezzeddine
authors.affiliation: Division of Hematology-Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA;
authors.forename: Veronika
authors.initials: V
authors.lastname: Bachanova
authors.affiliation: Division of Hematology-Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA;
authors.forename: Celalettin
authors.initials: C
authors.lastname: Ustun
keywords: Human herpesvirus 6; Hyponatremia; Immunocompromised host; Status epilepticus; Umbilical cord blood transplantation