Human Herpesvirus 6 Meningoencephalitis Successfully Treated with Ganciclovir in a Patient Who Underwent Allogeneic Bone Marrow Transplantation from an HLA-Identical Sibling

Abstract

Human herpesvirus 6 (HHV-6) has recently been recognized as an important pathogen in immunocompromised hosts, such as patients who have undergone allogeneic bone marrow transplantation (allo-BMT). Here we report a case of HHV-6 meningoencephalitis in a patient who underwent allo-BMT from an HLA-identical sibling. The patient suffered from headache, high fever, tremor, and disorientation on day 35 after allo-BMT. Findings at magnetic resonance imaging, electroencephalography, and routine cerebrospinal fluid (CSF) examination suggested the presence of viral meningoencephalitis. We diagnosed HHV-6 meningoencephalitis by means of polymerase chain reaction (PCR) analysis of a CSF specimen. Successful treatment was achieved with ganciclovir. Because HHV-6 encephalitis has a potentially fatal and fulminant course, it is necessary that HHV-6 encephalitis be recognized as one of the central nervous system complications that can follow allo-BMT. PCR analysis for HHV-6 in the CSF specimen is necessary for appropriate diagnosis and treatment.

Human herpesvirus 6 infections after liver transplantation

“…Acyclovir [73,81] No No Ganciclovir [66][67][68][70][71][72] Yes Yes Mutation in U38 DNA polymerase Mutation in U69 phosphotransferase Foscarnet [65,[82][83][84][85] Yes Yes 2 Mutation in U38 DNA polymerase Cidofovir [76,86,95] Yes Yes Mutation in U38 DNA polymerase Maribavir [87,88] No Not available Cyclopropavir [89] Yes…”

“…In vitro studies demonstrated the activity of ganciclovir against HHV-6 [64,65] . Clinically, ganciclovir has been shown to be effective in HHV-6 infected bone marrow transplant recipients [66][67][68][69][70] . Likewise, case reports suggest that ganciclovir is effective for the treatment of HHV-6 infections after liver transplantation [66][67][68][70][71][72] .…”

“…Clinically, ganciclovir has been shown to be effective in HHV-6 infected bone marrow transplant recipients [66][67][68][69][70] . Likewise, case reports suggest that ganciclovir is effective for the treatment of HHV-6 infections after liver transplantation [66][67][68][70][71][72] . Ganciclovir prophylaxis has been shown to be effective in preventing HHV-6 reactivation in stem cell transplant recipients [73][74][75] .…”

Human herpesvirus type 6 reactivation after haematopoietic stem cell transplantation

“…In most reports, some antiviral activity is reported for ganciclovir although in certain cases of fulminant HHV6 infection showed no response. [44][45][46][47][48] Use of ganciclovir is complicated by severe bone marrow suppression which is an unwanted side-effect early after HSCT. 49 As in almost all patients suffering from HHV6 reactivation, prophylactic acyclovir was prescribed to prevent VZV/HSV reactivation, acyclovir appears to be ineffective against HHV6.…”

Thrombotic microangiopathy (TMA) and stroke due to human herpesvirus‐6 (HHV‐6) reactivation in an adult receiving high‐dose melphalan with autologous peripheral stem cell transplantation

“…While ganciclovir appears to have a role in prophylaxis [39], preemptive therapy [40], and curative treatment [41], there are reports of patients developing HHV-6-induced encephalitis while on ganciclovir. There are several in vitro reports of ganciclovir resistance to HHV-6A strains [42].…”