Human herpesvirus‐6 encephalitis following chemotherapy induction for acute myelogenous leukemia

Frey, John W; Cherabie, Joseph; Assi, Maha

doi:10.1111/tid.12756

Cited by 7 publications

(2 citation statements)

References 20 publications

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“…While immunocompromised patients, especially those who have undergone allogeneic HSCT, are at a high risk of HHV-6 reactivation, 3 , 4 , 6 – 8 reactivation can also occur in association with intensive chemotherapy, hypogammaglobulinemia, and autologous HSCT. 5 , 9 , 20 , 21 It is noteworthy that HHV-6 reactivation has been frequently accompanied with the emergence of Pneumocystis jirovecii pneumonia and the reactivation of other viral pathogens, such as CMV or Epstein-Barr virus. 21 – 23 Our patient had a sustained immunosuppressive state with hypogammaglobulinemia and a low CD4/CD8 T cell ratio, with repeated CMV reactivation that might be caused by continuous steroid replacement therapy for primary hypogonadism and rituximab-containing salvage therapy for relapsed FL.…”

Section: Discussionmentioning

confidence: 99%

Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab

Kuwahara-Ota

Chinen

Mizuno

et al. 2018

IDR

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Primary infection with human herpesvirus-6 (HHV-6) commonly occurs at an early age in children, most often at 3 years of age, and is associated with childhood diseases, such as exanthema subitum, hepatitis, febrile convulsions, or encephalitis. However, the virus occasionally reactivates from its latent state in immunosuppressed adults, especially post-transplant, resulting in serious disseminated, sometimes life-threatening end-organ complications. Herein, we report a case of a 68-year-old man with relapsed follicular lymphoma who developed HHV-6 pneumonitis. Eighteen months after achieving second complete remission by salvage immunochemotherapy with rituximab, the patient was complicated by pneumonia, with chest computed tomography finding showing disseminated nodular shadows with ground-glass opacity in both lungs. While empiric antibiotic and antifungal therapies did not improve the pneumonia, polymerase chain reaction–based viral screening tests on his bronchoalveolar lavage fluid detected the presence of HHV-6 DNA, and ganciclovir treatment quickly resolved the pneumonia, indicating that he suffered from HHV-6 pneumonitis. He had no other HHV-6–related end-organ damage, such as encephalitis. This case suggests that, although extremely rare, HHV-6 reactivation should be considered as one of the candidate pathogens for pulmonary complications of uncertain etiology in patients who have been treated with intensive immunosuppressive chemotherapy, even without hematopoietic stem cell transplantation. Furthermore, polymerase chain reaction–based viral screening testing on bronchoalveolar lavage fluid is a powerful diagnostic tool for pneumonitis due to viral reactivation, including HHV-6 reactivation.

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Section: Discussionmentioning

confidence: 99%

Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab

Kuwahara-Ota

Chinen

Mizuno

et al. 2018

IDR

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“…The MRI findings of this patient are consistent with previous reports of HHV-6 encephalopathy, including, but not limited to, medial temporal lobe involvement [14][15][16][17] . However, HHV-6 encephalitis may not always be accompanied by radiologic correlates, especially when MRI is performed shortly after symptom onset [17][18][19] , so negative MRIs do not exclude HHV-6 encephalitis. Thus, repeating an early negative MRI may be beneficial.…”

Section: Diagnosis Of Hhv-6 Encephalitismentioning

confidence: 99%

Unique Challenges to Diagnosing Human Herpesvirus-6 (HHV-6) Encephalitis Following Post-Hematopoietic Stem Cell Transplant: A Case and Brief Review

et al. 2022

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A patient with an ultimate diagnosis of human herpesvirus-6 (HHV-6) encephalitis developed central nervous system (CNS) symptoms 13 days after undergoing myeloablative haploidentical allogeneic hematopoietic stem cell transplant (HSCT). Due to the patient’s body habitus, magnetic resonance (MR) imaging was not obtained until the onset of retrograde amnesia on day +24. MR imaging and other clinical findings eliminated all skepticism of HHV-6 encephalitis and HHV-6 antivirals were initiated on day +28, leading to gradual recovery. This case demonstrates some of the factors that may complicate the diagnosis of post-alloHSCT HHV-6 encephalitis. Because HHV-6 encephalitis and viremia can occur without warning, a single negative study should not exclude future development, especially if CNS symptoms are present. Acute graft-versus-host disease and cord blood transplantation are both significant risk factors for HHV-6 encephalitis. Human leukocyte antigen (HLA) mismatch, engraftment complications, or certain HLA alleles have also been associated with HHV-6 encephalitis. Chromosomally integrated HHV-6 must also be ruled out to prevent inappropriate and potentially harmful administration of antivirals. Due to the severe short- and long-term sequelae of HHV-6 encephalitis, appropriate treatment should be administered as soon as possible.

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Central Nervous System Infections in Neutropenic Cancer Patients

Moore-Pardo

Klinkova

2019

Infections in Neutropenic Cancer Patients

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Human herpesvirus‐6 encephalitis following chemotherapy induction for acute myelogenous leukemia

Cited by 7 publications

References 20 publications

Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab

Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab

Unique Challenges to Diagnosing Human Herpesvirus-6 (HHV-6) Encephalitis Following Post-Hematopoietic Stem Cell Transplant: A Case and Brief Review

Central Nervous System Infections in Neutropenic Cancer Patients

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