Human herpesvirus-6B active infection associated with relapsing bilateral anterior optic neuritis

Moschettini, Donatella; Franceschini, Rossella; Vaccaro, Nm; Cermelli, Claudio; Pezzini, Francesco; Balestrieri, M; Cerase, Alfonso; Bartalini, Simona; Ulivelli, Monica; Tosi, G; Donati, D.

doi:10.1016/j.jcv.2006.08.018

Cited by 12 publications

(13 citation statements)

References 12 publications

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“…43 HHV6 has been implicated in ocular inflammation, most notably when the posterior part of the eye was affected. 14,15,17,19 Our patient had anterior uveitis with heterochromia that had been present since childhood. Heterochromia is classically associated with FHUS but can develop in other viral infections such as HSV or VZV.…”

Section: Casementioning

confidence: 84%

Identification of New Pathogens in the Intraocular Fluid of Patients With Uveitis

Groot-Mijnes

Visser

Zuurveen

et al. 2010

American Journal of Ophthalmology

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Section: Casementioning

confidence: 84%

Identification of New Pathogens in the Intraocular Fluid of Patients With Uveitis

Groot-Mijnes

Visser

Zuurveen

et al. 2010

American Journal of Ophthalmology

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“…4 Optic neuritis has been reported with HHV6 infection only twice. 8,9 On clinical grounds, our patient had no evidence of immunosuppression, and so positivity for HHV6 in her first cerebrospinal fluid study could have resulted from viral latency after early childhood infection. However, we cannot without additional investigations (viral load, IgG antibodies) definitely confirm or exclude active HHV6 infection.…”

Section: Discussionmentioning

confidence: 79%

Postinfectious Anti–Myelin Oligodendrocyte Glycoprotein Antibody Positive Optic Neuritis and Myelitis

2017

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We report the case of a 9-year-old girl admitted with fever, headache, and a cerebrospinal fluid lymphocytic pleocytosis. Polymerase chain reaction was positive for human herpes virus 6. She subsequently developed ataxia and bilateral loss of vision. Magnetic resonance imaging (MRI) showed bilateral optic nerve lesions with extension to optic chiasm and a short-segment myelitis. Serologic studies were positive for Borrelia burgdorferi IgM. Anti-aquaporin 4 antibody was negative and anti-myelin oligodendrocyte glycoprotein antibody (MOG) positive. After intravenous methylprednisolone, ceftriaxone, and intravenous immunoglobulin, her vision slowly recovered. The patient was discharged with only mild visual acuity loss, 1 month after admission. Brain MRI was repeated later and was normal and MOG assay became negative. In our view, this patient suffered from a postinfectious, anti-MOG-mediated, spinal cord and optic nerve demyelination. Borrelia burgdorferi infection is associated with neurologic manifestations in up to 15% of cases.1 Optic neuritis related with Lyme borreliosis has been reported infrequently and there is uncertainty about the validity of the diagnosis in many cases.2 Neurologic manifestations associated with human herpes virus 6 (HHV6) infection are usually febrile seizures in infants and encephalitis in immunosuppressed patients. 3Optic neuritis may have multiple causes, including infection and several autoimmune diseases, such as multiple sclerosis, acute disseminated encephalomyelitis, or neuromyelitis optica spectrum disorders.We describe a case of one female adolescent with antimyelin oligodendrocyte glycoprotein (MOG)-positive optic neuritis and myelitis. She had a positive polymerase chain reaction for HHV6 in cerebrospinal fluid and positive enzyme-linked immunosorbent assay and Western blot for Borrelia burgdorferi in serum. We propose that our case expands the spectrum of the association between infection and immunemediated MOG demyelination. Case ReportA previously healthy 9-year-old girl of African descent living in the Azores Islands was admitted to her local hospital with a 6-day history of a febrile illness, headache, and somnolence, previously treated with amoxicillin-clavulanic acid without resolution of symptoms. She had no history of recent travel. Her white blood cell count was 16340/mL (80% neutrophils) and c-reactive protein 0.88 mg/dL. Cerebrospinal fluid examination revealed a cell count of 95 cells/mL, with lymphocytic predominance and elevated protein (66 mg/dL). Polymerase chain reaction in the cerebrospinal fluid was positive for HHV6 and negative for Borrelia burgdorferi, and no serologic tests were performed regarding HHV6. Four days later, she presented with gait imbalance, abdominal pain, and dysuria. Neurologic examination was positive for gait ataxia with a positive Romberg sign. She underwent treatment with a 21-day course of ganciclovir (10 mg/kg/d) and was discharged on the 26th day after admission with a normal physical examination. Brain

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“…In the case of eye diseases, it has been implicated in AIDSassociated retinitis, [1][2][3] uveitis, 4-8 corneal inflammation, 9 and optic neuropathy. [10][11][12] Two variants of HHV-6 have been identified. HHV-6A is less often associated with disease and has a greater predilection for neural cells than HHV-6B.…”

Section: Discussionmentioning

confidence: 99%

“…HHV-6 has been implicated in ocular inflammation, most remarkably when the posterior segment of the eye was affected. 6,7,[10][11][12] On the other hand, the role of HHV-6 as a cause of anterior uveitis is inconclusive and further studies are required. As revealed in this study, we found three cases of anterior inflammatory diseases including keratitis and five cases of pan-or posterior inflammatory diseases in the eye.…”

Section: Discussionmentioning

confidence: 99%

Virological Analysis in Patients with Human Herpes Virus 6–Associated Ocular Inflammatory Disorders

Sugita

Shimizu

Watanabe

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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Human herpesvirus-6B active infection associated with relapsing bilateral anterior optic neuritis

Cited by 12 publications

References 12 publications

Identification of New Pathogens in the Intraocular Fluid of Patients With Uveitis

Identification of New Pathogens in the Intraocular Fluid of Patients With Uveitis

Postinfectious Anti–Myelin Oligodendrocyte Glycoprotein Antibody Positive Optic Neuritis and Myelitis

Virological Analysis in Patients with Human Herpes Virus 6–Associated Ocular Inflammatory Disorders

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