Skip to main content

Advertisement

SpringerLink
Log in

A case of human herpesvirus 6 encephalitis following pediatric hematopoietic stem cell transplantation: early diagnosis and treatment matters

  • Case Report
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Human herpesvirus 6 (HHV-6) is one of the life-threatening infectious complications with significant morbidity and mortality following hematopoietic stem cell transplantation (HSCT). Clinically, the diagnosis of HHV-6 encephalitis can be challenging due to a lack of specific symptoms and definitive diagnostic tests. We report a pediatric HSCT recipient who developed late-onset HHV-6 encephalitis without typical radiographic findings. The routine viral infection monitoring protocol contributed to the prompt diagnosis of HHV-6 encephalitis and early therapeutic intervention. The patient was treated successfully without any neurological complications attributable to HHV-6 encephalitis. HHV-6 encephalitis should remain in the differential diagnosis as an important but treatable disease, even for several months after HSCT and even without radiographic findings. Whenever HHV-6 encephalitis is suspected, antivirals should be initiated promptly to prevent its complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

HHV-6:

Human herpesvirus 6

HSCT:

Hematopoietic stem cell transplantation

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

XIAP:

X-linked inhibitor of apoptosis

BMT:

Bone marrow transplantation

GVH:

Graft-versus-host

HVG:

Host-versus-graft

ATG:

Anti-thymocyte globulin

GVHD:

Graft-versus-host disease

HLH:

Hemophagocytic lymphohistiocytosis

CMV:

Cytomegalovirus

References

  1. Ogata M, Oshima K, Ikebe T, Takano K, Kanamori H, Kondo T, et al. Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2017;52:1563–70.

    Article  CAS  Google Scholar 

  2. Ward KN, Hill JA, Hubacek P, de la Camara R, Crocchiolo R, Einsele H, et al. Guidelines from the 2017 European Conference on Infections in Leukaemia for management of HHV-6 infection in patients with hematologic malignancies and after hematopoietic stem cell transplantation. Haematologica. 2019;104:2155–63.

    Article  Google Scholar 

  3. Granerod J, Cunningham R, Zuckerman M, Mutton K, Davies NW, Walsh AL, et al. Causality in acute encephalitis: defining aetiologies. Epidemiol Infect. 2010;138:783–800.

    Article  CAS  Google Scholar 

  4. Ogata M, Fukuda T, Teshima T. Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: what we do and do not know. Bone Marrow Transplant. 2015;50:1030–6.

    Article  CAS  Google Scholar 

  5. Ogata M, Satou T, Kadota J, Saito N, Yoshida T, Okumura H, et al. Human herpesvirus 6 (HHV-6) reactivation and HHV-6 encephalitis after allogeneic hematopoietic cell transplantation: a multicenter, prospective study. Clin Infect Dis. 2013;57:671–81.

    Article  Google Scholar 

  6. Scheurer ME, Pritchett JC, Amirian ES, Zemke NR, Lusso P, Ljungman P. HHV-6 encephalitis in umbilical cord blood transplantation: a systematic review and meta-analysis. Bone Marrow Transplant. 2013;48:574–80.

    Article  CAS  Google Scholar 

  7. de Pagter PJ, Schuurman R, Visscher H, de Vos M, Bierings M, van Loon AM, et al. Human herpes virus 6 plasma DNA positivity after hematopoietic stem cell transplantation in children: an important risk factor for clinical outcome. Biol Blood Marrow Transplant. 2008;14:831–9.

    Article  Google Scholar 

  8. Dulery R, Salleron J, Dewilde A, Rossignol J, Boyle EM, Gay J, et al. Early human herpesvirus type 6 reactivation after allogeneic stem cell transplantation: a large-scale clinical study. Biol Blood Marrow Transplant. 2011;18:1080–9.

    Article  Google Scholar 

  9. Wang LR, Dong LJ, Zhang MJ, Lu DP. The impact of human herpesvirus 6B reactivation on early complications following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2006;12:1031–7.

    Article  Google Scholar 

  10. Ogata M, Satou T, Kawano R, Takakura S, Goto K, Ikewaki J, et al. Correlations of HHV-6 viral load and plasma IL-6 concentration with HHV-6 encephalitis in allogeneic stem cell transplant recipients. Bone Marrow Transplant. 2010;45:129–36.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the medical editors from the Department of Education for Clinical Research of the National Center for Child Health and Development for editing this manuscript. This study was supported in part by a grant from the National Center for Child Health and Development, grant numbers 28-5 and 30-3.

Author information

Authors and Affiliations

  1. Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan

    Atsushi Sakamoto & Akira Ishiguro

  2. Department of Advanced Medicine for Viral Infections, Tokyo, Japan

    Atsushi Sakamoto, Masaki Yamada & Ken-Ichi Imadome

  3. Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan

    Shin-ichi Tsujimoto, Tomoo Osumi, Daisuke Tomizawa, Akira Ishiguro, Kimikazu Matsumoto & Motohiro Kato

  4. Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan

    Katsuhiro Arai

Authors
  1. Atsushi Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masaki Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shin-ichi Tsujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomoo Osumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katsuhiro Arai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daisuke Tomizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akira Ishiguro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kimikazu Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ken-Ichi Imadome
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Motohiro Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masaki Yamada.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakamoto, A., Yamada, M., Tsujimoto, Si. et al. A case of human herpesvirus 6 encephalitis following pediatric hematopoietic stem cell transplantation: early diagnosis and treatment matters. Int J Hematol 112, 751–754 (2020). https://doi.org/10.1007/s12185-020-02905-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-020-02905-x

Keywords

Search

Navigation