title: Acute myelitis by human herpes virus 7 in an HIV-infected patient.
abstract: BACKGROUND
  HHV7 reactivation has been occasionally reported as a cause of encephalitis or myelitis in transplant recipients, but to our knowledge it has never been associated with neurological disease in HIV-infected patients. We report a case of acute myelitis in an HIV-infected patient, with sustained HHV-7 DNA amplification in cerebrospinal fluid (CSF) and a favourable response to foscarnet.
  
  
  METHODS
  A 40 year-old man with HIV infection was admitted with asymmetric hypoesthesia in legs and paraparesis. He was receiving treatment with efavirenz, emtricitabine and tenofovir, his CD4 count was 580/mm3 and HIV viral load was undetectable. Magnetic resonance imaging showed a focal central hyperintensity on T2 and STIR sequences, on the torathic spinal cord, with slight enhancement after intravenous gadolinium. All microbiological studies were negative except for HHV-7 DNA amplification in CSF. With a diagnosis of idiopathic transverse myelitis, treatment with high-dose intravenous methylprednisolone was initiated. However, paraparesis continued worsening, and a second CSF obtained 12 days after the first one resulted again in HHV-7 amplification.
  
  
  RESULTS
  The patient was treated with a 2 week course of foscarnet, and a rapid neurological improvement was noted. After treatment, PCR for HHV-7 in CSF was negative. Neurological exam was normal one month after treatment initiation.
  
  
  CONCLUSIONS
  HHV-7 reactivation may cause neurological disease in patients with HIV infection. Foscarnet is an effective treatment in HHV-7 associated myelitis.
authors.affiliation: Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain. Electronic address: alfesvi@gmail.com.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Escobar-Villalba
authors.affiliation: Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Sainz de la Maza
authors.affiliation: Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Pérez Torre
authors.affiliation: Department of Microbiology Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) and CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Galán
authors.affiliation: Department of Microbiology Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) and CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Rodríguez-Domínguez
authors.affiliation: Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Monreal Laguillo
authors.affiliation: Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain.
authors.forename: Pedro Luis
authors.initials: PL
authors.lastname: Martínez Ulloa
authors.affiliation: Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Buisán Catevilla
authors.affiliation: Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain.
authors.forename: Iñigo
authors.initials: I
authors.lastname: Corral
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D004279:DNA, Viral; D017245:Foscarnet / Q000627:therapeutic use; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D016199:Herpesvirus 7, Human / Q000235:genetics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009187:Myelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology*; D019349:Roseolovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D013116:Spinal Cord / Q000473:pathology; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D017245:Foscarnet
keywords: Foscarnet; HIV; Human herpesvirus-7; Myelitis