title: Pediatric Hemorrhagic Brainstem Encephalitis Associated With HHV-7 Infection.
abstract: BACKGROUND
  Human herpesviruses-6 and -7 have been associated with febrile seizures and with encephalitis, the latter predominantly in immunocompromised individuals. Acute hemorrhagic encephalitis is frequently a fatal disease that can occur in the setting of viral infection or can be a postinfectious phenomenon, often with no cause identified. Although hemorrhagic encephalitis has been reported with human herpesvirus-6 infection, only one individual, an immunocompromised child, has been documented with human herpesvirus-7 infection. The role of immunosuppression is not well-established in the management of this rare condition.
  
  
  METHODS
  We present an 11-year-old boy with hemorrhagic brainstem encephalitis who underwent extensive infectious and autoimmune testing, positive only for human herpesvirus-7 in the cerebrospinal fluid. The patient recovered after treatment with intravenous immunoglobulin, high-dose steroids, and plasma exchange.
  
  
  CONCLUSIONS
  This is the first report of hemorrhagic brainstem encephalitis with human herpesvirus-7 in a previously healthy individual, adding to existing reports of late-onset human herpesvirus-7 infection associated with encephalitis in children. It also underscores that aggressive immunosuppression may be used early in the course of this disorder and may be beneficial for recovery.
authors.affiliation: Department of Pediatric Neurology, Washington University, St. Louis, Missouri. Electronic address: faya@neuro.wustl.edu.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Fay
authors.affiliation: Department of Pediatric Neurology, Washington University, St. Louis, Missouri.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Noetzel
authors.affiliation: Department of Pediatric Neurology, Washington University, St. Louis, Missouri.
authors.forename: Soe S
authors.initials: SS
authors.lastname: Mar
mesh_terms: D001933:Brain Stem / Q000473:pathology*; D002648:Child; D018792:Encephalitis, Viral / Q000150:complications* / Q000175:diagnosis; D016199:Herpesvirus 7, Human / Q000472:pathogenicity*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D019349:Roseolovirus Infections / Q000150:complications* / Q000175:diagnosis
keywords: HHV-7; hemorrhagic encephalitis; herpesvirus; pediatric