Top

Published in:

01-12-2017 | Case Report

Successful treatment and FDG-PET/CT monitoring of HHV-6 encephalitis in a non-neutropenic patient: case report and literature review

Authors: Elda Righi, Alessia Carnelutti, Daniele Muser, Francesco Zaja, Elisa Lucchini, Federico Pea, Fernando Di Gregorio, Abass Alavi, Matteo Bassetti

Published in: Journal of NeuroVirology | Issue 6/2017

Abstract

Human herpesvirus (HHV)-6 reactivation is associated with severe forms of encephalitis among patients undergoing hematopoietic stem cell transplantation. Cases in non-neutropenic patients are uncommon. The efficacy of ganciclovir and other compounds that are used for the treatment of HHV-6 encephalitis remains suboptimal and linked to toxicity. Valganciclovir, the oral prodrug of ganciclovir, could be practical to treat outpatients, but it is not commonly used for severe cases. We report a case of HHV-6 encephalitis in a non-neutropenic patient successfully treated with valganciclovir and undergoing therapeutic drug monitoring in plasma and in the cerebrospinal fluid. Resolution of infectious foci was documented by cerebral MRI and F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). A review of the literature on HHV-6 encephalitis is also reported.

Available only for authorised users

Bassetti M, Merelli M, Di Gregorio F et al (2017) Higher fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) uptake in tuberculous compared to bacterial spondylodiscitis. Skeletal Radiol 46:777CrossRefPubMed

Biron KK (2006) Antiviral drugs for cytomegalovirus diseases. Antivir Res 71:154–163CrossRefPubMed

Bommer M, Pauls S, Greiner J (2009) Challenging complications of treatment-human herpes virus 6 encephalitis and pneumonitis in a patient undergoing autologous stem cell transplantation for relapsed Hodgkin's disease: a case report. Virol J 6:111CrossRefPubMedPubMedCentral

Boutolleau D, Duros C, Bonnafous P et al (2006) Identification of human herpesvirus 6 variants A and B by primer-specific real-time PCR may help to revisit their respective role in pathology. J Clin Virol 35:257–263CrossRefPubMed

Braun DK, Dominguez G, Pellet PE (1997) Human herpesvirus 6. Clin Microbiol Rev 10:521–567PubMedPubMedCentral

Caserta MT, Mock DJ, Dewhurst S (2001) Human herpesvirus 6. Clin Infect Dis 33:829–833CrossRefPubMed

Collot S, Petit B, Bordessoule D, Alain S, Touati M, Denis F, Ranger-Rogez S (2002) Real-time PCR for quantification of human herpesvirus 6 DNA from lymph nodes and saliva. J Clin Microbiol 40:2445–2451CrossRefPubMedPubMedCentral

Cone RW, Huang ML, Ashley R, Corey L (1993) Human herpesvirus 6 DNA in peripheral blood cells and saliva from immunocompetent individuals. J Clin Microbiol 31:1262–1267PubMedPubMedCentral

Cuomo L, Trivedi P, Cardillo MR, Gagliardi FM, Vecchione A, Caruso R, Calogero A, Frati L, Faggioni A, Ragona G (2001) Human herpesvirus 6 infection in neoplastic and normal brain tissue. J Med Virol 63:645–651CrossRef

De Bolle L, Naesens L, De Clercq E (2005) Update on human herpesvirus 6 biology, clinical features, and therapy. Clin Microbiol Rev 18:217–245CrossRefPubMedPubMedCentral

Flamand L, Gravel A, Boutolleau D et al (2008) Multicenter comparison of PCR assays for detection of human herpesvirus 6 DNA in serum. J Clin Microbiol 46:2700–2706CrossRefPubMedPubMedCentral

Isaacson E, Glaser CA, Forghiani B, Amad Z, Wallace M, Armstrong RW, Exner MM, Shmid S (2005) Evidence of human herpesvirus 6 infection in 4 immunocompetent patients with encephalitis. Clin Infect Dis 15:890–893CrossRef

Janoly-Duménil A, Galambrun C, Basset T, Mialou V, Bertrand Y, Bleyzac N (2006) Human herpes virus-6 encephalitis in a paediatric bone marrow recipient: successful treatment with pharmacokinetic monitoring and high doses of ganciclovir. Bone Marrow Transplant 38:769–770CrossRefPubMed

Ljungman P, Hakki PM, Michael Boeckh M (2011) Cytomegalovirus in hematopoietic stem cell transplant recipients. Hematol Oncol Clin North Am 25:151–169CrossRefPubMedPubMedCentral

Locatelli G, Santoro F, Veglia F, Gobbi A, Lusso P, Malnati MS (2000) Real-time quantitative PCRfor human herpesvirus 6 DNA. J Clin Microbiol 38:4042–4048PubMedPubMedCentral

Manichanh C, Grenot P, Gautheret-Dejean A (2000) Susceptibility of human herpesvirus 6 to antiviral compounds by flow cytometry analysis. Cytometry 40:135–140CrossRefPubMed

Nau R, Sörgel F, Eiffert H (2010) Penetration of drugs through the blood- cerebrospinal fluid/blood–brain barrier for treatment of central nervous system infections. Clin Microbiol Rev 23:858–883CrossRefPubMedPubMedCentral

Ogata M, Satou T, Kadota J, Saito N, Yoshida T, Okumura H, Ueki T, Nagafuji K, Kako S, Uoshima N, Tsudo M, Itamura H, Fukuda T (2013) Clin Infect Dis 57:671–681CrossRefPubMed

Razonable RR, Fanning C, Brown RA et al (2002) Selective reactivation of human herpesvirus 6 variant a occurs in critically ill immunocompetent hosts. J Infect Dis 185:110–113CrossRefPubMed

Seeley WW, Marty FM, Holmes TM, Upchurch K, Soiffer RJ, Antin JH, Baden LR, Bromfield EB (2007) Posttransplant acute limbic encephalitis: clinical features and relationship to HHV-6. Neurology 69:156–165CrossRefPubMed

Tavakoli NP, Nattanmai S, Hull R, Fusco H, Dzigua L, Wang H, Dupuis M (2007) Detection and typing of human herpesvirus 6 by molecular methods in specimens from patients diagnosed with encephalitis or meningitis. J Clin Microbiol 45:3972–3978CrossRefPubMedPubMedCentral

Trabue CH, Bloch KC, Myers JW, Moorman JP (2008) Case report and literature review: HHV-6-associated meningoencephalitis in an immunocompetent adult. Herpesviridae 15:33–35

Vethamuthu J, Feber J, Chretien A, Lampe D, Filler G (2007) Unexpectedly high inter- and intrapatient variability of ganciclovir levels in children. Pediatr Transplant 11:301–305CrossRefPubMed

Vezina HE, Brundage RC, Balfour HH Jr (2014) Population pharmacokinetics of valganciclovir prophylaxis in paediatric and adult solid organ transplant recipients. Br J Clin Pharmacol 78:343–352CrossRefPubMedPubMedCentral

Wainwright MS, Martin PL, Morse RP et al (2001) Human herpesvirus 6 limbic encephalitis after stem cell transplantation. Ann Neurol 50(5):612–619CrossRefPubMed

Yoshida M, Yamada M, Tsukazaki T et al (1998) Comparison of antiviral compounds against human herpesvirus 6 and 7. Antivir Res 40:73–84CrossRefPubMed

Zerr DM (2006) Human herpesvirus 6 and central nervous system disease in hematopoietic cell transplantation. J Clin Virol 37:S52–S56CrossRefPubMed

Zhao W, Fakhoury M, Fila M, Badouin V, Deschenes G, Jacqz-Aigrain E (2012) Individualization of valganciclovir prophylaxis for cytomegalovirus infection in pediatric kidney transplant patients. Ther Drug Monit 34:326–330CrossRefPubMed

Title: Successful treatment and FDG-PET/CT monitoring of HHV-6 encephalitis in a non-neutropenic patient: case report and literature review
Authors: Elda Righi
Alessia Carnelutti
Daniele Muser
Francesco Zaja
Elisa Lucchini
Federico Pea
Fernando Di Gregorio
Abass Alavi
Matteo Bassetti
Publication date: 01-12-2017
Publisher: Springer International Publishing
Published in: Journal of NeuroVirology / Issue 6/2017
Print ISSN: 1355-0284
Electronic ISSN: 1538-2443
DOI: https://doi.org/10.1007/s13365-017-0566-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Successful treatment and FDG-PET/CT monitoring of HHV-6 encephalitis in a non-neutropenic patient: case report and literature review

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2017

Ocular flutter following Zika virus infection

A neuropathic pain syndrome associated with hantavirus infection

Role of the inflammasome-related cytokines Il-1 and Il-18 during infection with murine coronavirus

Association of age and time of disease with HIV-associated neurocognitive disorders: a Japanese nationwide multicenter study

Central nervous system-penetrating antiretrovirals impair energetic reserve in striatal nerve terminals

Prevalence of a history of prior varicella/herpes zoster infection in multiple sclerosis