Bilateral optic neuropathy and unilateral tonic pupil associated with acute human herpesvirus 6 infection: a case report

  • Isabel M. Oberacher-Velten
  • Jost B. Jonas
  • Anselm Jünemann
  • Barbara Schmidt
Short Communication



Human herpesvirus 6 (HHV-6), a widespread virus and causative agent of exanthema subitum in children, has been associated with a number of neurologic disorders including cranial nerve palsies, seizures, encephalitis, meningitis, and multiple sclerosis.


A 31-year-old man presented with bilateral optic neuropathy, disc edema, and unilateral tonic pupil, which were found to be associated with acute HHV-6 infection. The patient had been suffering from juvenile diabetes for 5 years. One week after onset of intravenous antiviral therapy with foscarnet, disc edema subsided, and tonic pupil reaction was no longer detectable.


HHV-6 infection may play a role as a causative agent in patients with optic neuropathy and tonic pupil.


Human herpesvirus 6 Optic neuropathy Disc edema Tonic pupil 


  1. 1.
    Challoner PB, Smith KT, Parker JD, MacLeod DL, Coulter SN, Rose TM, Schultz ER, Bennett JL, Garber RL, Chang M et al (1995) Plaque-associated expression of human herpesvirus 6 in multiple sclerosis. Proc Natl Acad Sci USA 92(16):7440–7444PubMedGoogle Scholar
  2. 2.
    Daibata M, Komatsu T, Taguchi H (2000) Human herpesviruses in primary ocular lymphoma. Leuk Lymphoma 37(3–4):361–365PubMedGoogle Scholar
  3. 3.
    Dewhurst S, Skrincosky D, van Loon N (1997) Human herpesvirus 6. Expert Rev Mol Med 5:1–17Google Scholar
  4. 4.
    Donati D, Akhuyani N, Fogdell-Hahn A, Cermelli C, Cassiani-Ingoni R, Vortmeyer A, Heiss JD, Cogen P, Gaillard WD, Sato S, Theodore WH, Jacobson S (2003) Detection of human herpesvirus-6 in mesial temporal lobe epilepsy surgical brain resections. Neurology 61(10):1405–1411PubMedGoogle Scholar
  5. 5.
    Fillet AM, Reux I, Joberty C, Fournier JG, Hauw JJ, Le Hoang P, Bricaire F, Huraux JM, Agut H (1996) Detection of human herpes virus 6 in AIDS-associated retinitis by means of in situ hybridization, polymerase chain reaction and immunohistochemistry. J Med Virol 49(4):289–295CrossRefPubMedGoogle Scholar
  6. 6.
    Khare MD (2001) Human herpesvirus 6: its impact and influence on infectious diseases and their management. Expert Opin Pharmacother 2(2):213–221PubMedGoogle Scholar
  7. 7.
    Kimberlin DW, Whitley RJ (1998) Human herpesvirus-6: neurologic implications of a newly-described viral pathogen. J Neurovirol 5:474–485Google Scholar
  8. 8.
    Qavi HB, Green MT, Lewis DE, Hollinger FB, Pearson G, Ablashi DV (1995) HIV-1 and HHV-6 antigens and transcripts in retinas of patients with AIDS in the absence of human cytomegalovirus. Invest Ophthalmol Vis Sci 36(101):2040–2047PubMedGoogle Scholar
  9. 9.
    Qavi HB, Xu B, Green MT, Lusso P, Pearson G, Ablashi DV (1996) Morphological and ultrastructural changes induces in corneal epithelial cells by HIV-1 and HHV-6 in vitro. Curr Eye Res 15(6):597–604PubMedGoogle Scholar
  10. 10.
    Thierfelder S, Pfenningsdorf S, Grehn F (1997) Trochlear palsy in acute human virus (HHV) 6 subtype B infection. Klin Monatsbl Augenheilkd 211:403–405PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Isabel M. Oberacher-Velten
    • 1
  • Jost B. Jonas
    • 1
    • 2
  • Anselm Jünemann
    • 1
  • Barbara Schmidt
    • 3
  1. 1.Department of Ophthalmology and University Eye HospitalUniversity of Erlangen-NürnbergErlangenGermany
  2. 2.Department of Ophthalmology and University Eye Hospital MannheimUniversity of HeidelbergMannheimGermany
  3. 3.Department of VirologyUniversity of Erlangen-NürnbergErlangenGermany

Personalised recommendations