Human Herpes Virus 6 Encephalitis Following Bone Marrow Transplantation with Uncommon Magnetic Resonance Imaging Findings

다국어 초록 (Multilingual Abstract)

Background Human Herpes Virus 6 (HHV6) is commonly associated with encephalitis following bone marrow transplantation. However,hippocampal atrophy and global hypometabolism are rare findings in HHV6 encephalitis.
Case Report A 41-year-old right-handed woman with acute lymphoblastic leukemia presented with fever and mental changes 2 weeks afterreceiving a sibling bone marrow transplant. The patient’s cerebrospinal fluid (CSF) was positive for HHV-6 deoxyribonucleic acid (DNA),but was negative for other viral DNA. Brain magnetic resonance imaging revealed atrophic changes in bilateral medial temporal lobes. Following4 weeks of ganciclovir therapy, a CSF exam was negative for HHV-6 DNA and the patient’s neurological symptoms partially improved.
However, she was disoriented and had severe retrograde and anterograde amnesia. 18F-fluorodeoxyglucose-positron emission tomographyindicated global hypometabolism in the medial temporal lobes and the fronto-parietal cortices.
Conclusions This is a rare and unusual case of hippocampal atrophy in the acute stage of HHV6 encephalitis. Our imaging findings mayreflect the chronic indolent course of HHV6 encephalitis.

참고문헌 (Reference)

1 De Bolle L, "Update on human herpesvirus 6 biology, clinical features, and therapy" 18 : 217-245, 2005

2 Hubele F, "Sequential FDG PET and MRI findings in a case of human herpes virus 6 limbic encephalitis" 37 : 716-717, 2012

3 Millichap JJ, "Role of HHV-6B Infection in Mesial Temporal Lobe Epilepsy" 29 : 40-, 2015

4 Yamane A, "Risk factors for developing human herpesvirus 6(HHV-6)reactivation after allogeneic hematopoietic stem cell transplantation and its association with central nervous system disorders" 13 : 100-106, 2007

5 Seeley WW, "Post-transplant acute limbic encephalitis : clinical features and relationship to HHV6" 69 : 156-165, 2007

6 Kawamura Y, "Pathogenic Role of Human Herpesvirus 6B Infection in Mesial Temporal Lobe Epilepsy" 212 : 1014-1021, 2015

7 Gorniak RJ, "MR imaging of human herpesvirus-6-associated encephalitis in 4 patients with anterograde amnesia after allogeneic hematopoietic stem-cell transplantation" 27 : 887-891, 2006

8 Noguchi T, "MR imaging of human herpesvirus-6 encephalopathy after hematopoietic stem cell transplantation in adults" 27 : 2191-2195, 2006

9 Scoville WB, "Loss of recent memory after bilateral hippocampal lesions. 1957" 12 : 103-113, 2000

10 Milner B, "Loss of recent memory after bilateral hippocampal lesions : memory and memories-looking back and looking forward" 87 : 230-, 2016

11 Scoville WB, "Loss of recent memory after bilateral hippocampal lesions" 20 : 11-21, 1957

12 Salahuddin SZ, "Isolation of a new virus, HBLV, in patients with lymphoproliferative disorders" 234 : 596-601, 1986

13 Yamanishi K, "Identification of human herpesvirus-6 as a causal agent for exanthem subitum" 1 : 1065-1067, 1988

14 Vu T, "Human herpesvirus-6 encephalitis following allogeneic hematopoietic stem cell transplantation" 39 : 705-709, 2007

15 Ogata M, "Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation : what we do and do not know" 50 : 1030-1036, 2015

16 Dominguez G, "Human herpesvirus 6B genome sequence : coding content and comparison with human herpesvirus 6A" 73 : 8040-8052, 1999

17 Ogata M, "Human herpesvirus 6(HHV-6)reactivation and HHV-6 encephalitis after allogeneic hematopoietic cell transplantation : a multicenter, prospective study" 57 : 671-681, 2013

18 Wainwright MS, "Human herpesvirus 6 limbic encephalitis after stem cell transplantation" 50 : 612-619, 2001

19 Yoshikawa T, "Human herpesvirus 6 infection in hematopoietic stem cell transplant patients" 124 : 421-432, 2004

20 Ogata M, "Human herpesvirus 6 DNA in plasma after allogeneic stem cell transplantation : incidence and clinical significance" 193 : 68-79, 2006

21 Leibovitch EC, "Human Herpesvirus 6 as a Viral Trigger in Mesial Temporal Lobe Epilepsy" 212 : 1011-1013, 2015

22 Isaacson E, "Evidence of human herpesvirus 6 infection in 4 immunocompetent patients with encephalitis" 40 : 890-893, 2005

23 Provenzale JM, "Clinical and imaging findings suggesting human herpesvirus 6 encephalitis" 42 : 32-39, 2010

24 Drobyski WR, "Brief report : fatal encephalitis due to variant B human herpesvirus-6 infection in a bone marrow-transplant recipient" 330 : 1356-1360, 1994

25 Zerr DM, "A population-based study of primary human herpesvirus 6 infection" 352 : 768-776, 2005