title: Human herpesvirus 6 encephalitis followed by acute disseminated encephalomyelitis in an immunocompetent adult.
abstract: A 26-year-old, otherwise healthy man presented with visual abnormality followed by loss of consciousness and convulsion. The patient then developed headache and fever 14 days later. Brain MRI showed hyperintensities in the left cingulate cortex. The cerrebrospinal fluid examinations showed mononuclear pleocytosis and positive PCR results for human herpesvirus 6 (HHV-6). A diagnosis of HHV-6 encephalitis and symptomatic epilepsy was made. The patient's clinical symptoms improved promptly following acyclovir treatment. However, 3 months later the patient noticed dysesthesia in the trunk, the left upper limb and the right lower limb. Brain and spine MRI showed multiple brain white matter lesions, the middle cerebellar peduncle and cervical spinal lesions. The symptoms resolved following methylprednisolone pulse therapy only. We report an adult patient with HHV-6 encephalitis followed by acute disseminated encephalomyelitis whose initial presentation was epilepsy. HHV-6 encephalitis should be included in the differential diagnosis of encephalitis of unknown etiology in an immunocompetent adult.
authors.affiliation: Department of Neurology, Dokkyo Medical University.
authors.forename: Junichi
authors.initials: J
authors.lastname: Horie
authors.affiliation: Department of Neurology, Dokkyo Medical University.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Neurology, Rehabilitation Amakusa Hospital.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Neurology, Dokkyo Medical University.
authors.forename: Madoka
authors.initials: M
authors.lastname: Okamura
authors.affiliation: Department of Neurology, Dokkyo Medical University.
authors.forename: Akio
authors.initials: A
authors.lastname: Iwasaki
authors.affiliation: Department of Neurology, Dokkyo Medical University.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001921:Brain / Q000000981:diagnostic imaging; D002574:Cervical Vertebrae; D004660:Encephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology*; D004673:Encephalomyelitis, Acute Disseminated / Q000188:drug therapy / Q000209:etiology*; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D020551:Pulse Therapy, Drug; D019349:Roseolovirus Infections; D013116:Spinal Cord / Q000000981:diagnostic imaging; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008775:Methylprednisolone
keywords: HHV-6 encephalitis; acute disseminated encephalomyelitis; epilepsy; immunocompetent adult