title: Human herpes virus-6 encephalitis causing severe anterograde amnesia associated with rituximab, azathioprine and prednisolone combination therapy for dermatomyositis.
abstract: Human herpes virus-6 (HHV-6) reactivation is a well-recognised complication following haematological stem cell transplantation, but it is novel in the context of combination immunomodulatory therapy for autoimmune disease. We report a case of severe anterograde amnesia caused by HHV-6 encephalitis in a young female patient on rituximab, azathioprine and prednisolone for dermatomyositis (DM). The use of targeted biologic treatments for systemic autoimmune connective tissue diseases (CTDs) is increasing, particularly when refractory to conventional management. The anti-CD20 B cell depleting monoclonal antibody, rituximab is now increasingly used, often in combination with conventional immunomodulatory treatments, in certain autoimmune neurological conditions and systemic CTDs including DM. Physicians should be aware of the possibility of HHV-6 in those who develop encephalitis while CD20 B cell deplete, especially in the presence of additional immunomodulatory therapies. Prompt diagnosis and treatment of HHV-6 encephalitis with evidence-based anti-viral therapy may help reduce the extent of irreversible morbidity such as amnesia.
authors.affiliation: Department of Neurosciences, North Bristol NHS Trust, Southmead Hospital, Bristol, UK. tb2001uk@hotmail.com.|Department of Rheumatology, Autoimmune CTD and Vasculitis, North Bristol NHS Trust, Southmead Hospital, Bristol, UK. tb2001uk@hotmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Baumer
authors.affiliation: Department of Neurosciences, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
authors.forename: Charlie
authors.initials: C
authors.lastname: Fry
authors.affiliation: Department of Neurosciences, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Luppe
authors.affiliation: Department of Rheumatology, Autoimmune CTD and Vasculitis, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
authors.forename: Harsha
authors.initials: H
authors.lastname: Gunawardena
authors.affiliation: Department of Neurosciences, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
authors.forename: Kasia
authors.initials: K
authors.lastname: Sieradzan
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D020324:Amnesia, Anterograde / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000821:virology*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001379:Azathioprine / Q000009:adverse effects; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D003882:Dermatomyositis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D018792:Encephalitis, Viral / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D005260:Female; D015654:Herpesvirus 6, Human / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects; D008212:Lymphocyte Depletion; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011239:Prednisolone / Q000009:adverse effects; D000069283:Rituximab / Q000009:adverse effects; D019349:Roseolovirus Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000821:virology*
chemical_list: D000998:Antiviral Agents; D007155:Immunologic Factors; D000077725:Piperacillin, Tazobactam Drug Combination; D000069283:Rituximab; D010397:Penicillanic Acid; D011239:Prednisolone; D001379:Azathioprine; D010878:Piperacillin; D000212:Acyclovir
keywords: Amnesia; Dermatomyositis; Encephalitis; HHV-6; Rituximab