Human Herpesvirus 6 (HHV-6) necrotizing encephalitis, a rare condition in immunocompromised patients: The importance of brain biopsy associated with HHV-6 testing

Guennec, Loïc Le; Mokhtari, Karima; Chauvet, Dorian; Dupuis, Nina; Roos‐Weil, Damien; Agut, Henri; Leclercq, Delphine; Psimaras, Dimitri; Mayaux, Julien; Demeret, Sophie; Choquet, Sylvain; Auvin, Stéphane; Bonnafous, Pascale; Gautheret‐Dejean, Agnès; Weiss, Nicolas

doi:10.1016/j.jns.2017.04.003

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…Although systemic immune dysfunction has been observed, local virus-associated inflammation of nervous structures resulting in altered CNS and peripheral nervous system signalling has also been hypothesized as a mechanism behind ME/CFS [ 223 , 224 ], and neuroinflammation has been observed in patients [ 225 ]. EBV [ 226 ], HSV [ 227 ], HHV-6 [ 228 ], CMV [ 229 ], VZV [ 230 ], enterovirus [ 231 ], and B19V [ 232 ] can all infect the brain. Notably, HHV-6A is able to induce neuroinflammation in the absence of active replication in a mouse model [ 233 ].…”

Section: Molecular Mechanisms Behind Viral Pathogenesis In Me/cfsmentioning

confidence: 99%

Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

et al. 2018

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Background and main textMyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and controversial clinical condition without having established causative factors. Increasing numbers of cases during past decade have created awareness among patients as well as healthcare professionals. Chronic viral infection as a cause of ME/CFS has long been debated. However, lack of large studies involving well-designed patient groups and validated experimental set ups have hindered our knowledge about this disease. Moreover, recent developments regarding molecular mechanism of pathogenesis of various infectious agents cast doubts over validity of several of the past studies.ConclusionsThis review aims to compile all the studies done so far to investigate various viral agents that could be associated with ME/CFS. Furthermore, we suggest strategies to better design future studies on the role of viral infections in ME/CFS.

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Section: Molecular Mechanisms Behind Viral Pathogenesis In Me/cfsmentioning

confidence: 99%

Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

et al. 2018

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“…Although the disease is a rare event, it should be taken into account in an immunocompromised patient with necrotizing brain lesions. Brain biopsy should be considered because it is important that patients receive a proper diagnosis in order to possibly benefit from an antiviral therapy combining foscarnet and ganciclovir (3). In this context, advanced imaging modalities like FET-PET or MRI spectroscopy may be of help and should be further investigated for their usefulness in making the differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Case Report: A Case of Severe Clinical Deterioration in a Patient With Multiple Sclerosis

et al. 2020

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Tumefactive multiple sclerosis (MS) is a rare variant of MS that may lead to a rapidly progressive clinical deterioration requiring a multidisciplinary diagnostic workup. Our report describes the diagnostic and therapeutic approach of a rare and extremely severe course of MS. A 51-year-old man with an 8-year history of relapsing-remitting MS (RRMS) was admitted with a subacute progressive left lower limb weakness and deterioration of walking ability. After extensive investigations including repeated MRI, microbiological, serological, cerebrospinal fluid (CSF) studies, and finally brain biopsy, the diagnosis of a tumefactive MS lesion was confirmed. Despite repeated intravenous (IV) steroids as well as plasma exchanges and IV foscarnet and ganciclovir owing to low copy numbers of human herpesvirus 6 (HHV-6) DNA in polymerase chain reaction (PCR) analysis, the patient did not recover. The clinical presentation of tumefactive MS is rare and variable. Brain biopsy for histopathological workup should be considered in immunocompromised patients with rapidly progressive clinical deterioration with brain lesions of uncertain cause.

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“…HHV6 usually causes neurological disease when it reactivates in immunocompromised patients, particularly those with depressed T-cell mediated immunity (eg, stem cell transplant recipients). 55 In the post-transplant setting, an acute limbic encephalitis associated with HHV6 in CSF has been well described. 56 Clinical features are compatible with other causes of limbic encephalitis, and brain MRI shows T2-hyperintensity involving the mesial temporal lobe(s).…”

Section: Introduction: Approach To the Patientmentioning

confidence: 99%

Neurology of Acute Viral Infections

Krett

Beckham

Tyler

et al. 2022

The Neurohospitalist

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As specialists in acute neurology, neurohospitalists are often called upon to diagnose and manage acute viral infections affecting the nervous system. In this broad review covering the neurology of several acute viral infections, our aim is to provide key diagnostic and therapeutic pearls of practical use to the busy neurohospitalist. We will review acute presentations, diagnosis, and treatment of human herpesviruses, arboviruses, enteroviruses, and some vaccine-preventable viruses. The neurological effects of coronaviruses, including COVID-19, are not covered in this review.

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Human Herpesvirus 6 (HHV-6) necrotizing encephalitis, a rare condition in immunocompromised patients: The importance of brain biopsy associated with HHV-6 testing

Cited by 5 publications

References 12 publications

Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Case Report: A Case of Severe Clinical Deterioration in a Patient With Multiple Sclerosis

Neurology of Acute Viral Infections

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