Clinical characteristics of human herpesvirus-6 myelitis after allogeneic hematopoietic stem cell transplantation and its favorable outcome by early intervention

Shiroshita, Kohei; Mori, Takehiko; Kato, Jun; Sakurai, Masatoshi; Koda, Yuya; Abe, Ryohei; Murakami, Koichi; Sumiya, Chieko; Fujita, Shinya; Yamaguchi, Kentaro; Yamazaki, Rie; Nakayama, Hitomi; Suzuki, Shigeaki; Nakahara, Jin; Okamoto, Shinichiro

doi:10.1038/s41409-019-0755-2

Cited by 14 publications

(11 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The decline in viral copies after treatment with ganciclovir also supports HHV6 reactivation. Second to encephalitis, HHV6 myelitis is a relatively common manifestation of HHV6 reactivation in immunocompromised patients (Shiroshita et al, 2020). Therefore, the occurrence of this typical presentation in our immunodeficient patient with positive HHV6 PCR in CSF, CSF pleocytosis in the typical viral range, and good clinical and serological response to ganciclovir is less likely to be a rare coincidence.…”

Section: Discussionmentioning

confidence: 69%

“…This, in addition to the hypogammaglobulinemia seen in a subset of patients (Dupont et al, 2020), creates an acquired immunocompromised state during COVID-19 infection as evidenced by an increased susceptibility to secondary bacterial infections and viral reactivation (Li et al, 2020;Drago et al, 2020;Abadías-Granado et al, 2021). HHV6 myelitis is a rare disorder that is almost exclusively seen in immunocompromised patients such as post bone marrow transplantation and in the setting of HIV infection (Shiroshita et al, 2020). Given that our patient had no prior history of immunodeficiency and tested negative for HIV, the most likely trigger of his HHV6 reactivation was COVID-19-induced immunodeficiency.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

COVID-19, HHV6 and MOG antibody: A perfect storm

Jumah

Rahman

Figgie

et al. 2021

Journal of Neuroimmunology

View full text Add to dashboard Cite

Background: Serious neurological complications of SARS-CoV-2 are increasingly being recognized. Case: We report a novel case of HHV6 myelitis with parainfectious MOG-IgG in the setting of COVID-19-induced lymphopenia and hypogammaglobulinemia. The patient experienced complete neurological recovery with gancyclovir, high dose corticosteroids, and plasma exchange. To our knowledge, this is the first case of HHV6 reactivation in the central nervous system in the setting of COVID19 infection and the first case of MOG-IgG myelitis in the setting of SARS-CoV-2 and HHV6 coinfection. Conclusion: Patients with neurological manifestations in the setting of COVID19-related immunodeficiency should be tested for opportunistic infections including HHV6. Viral infection is a known trigger for MOG-IgG and therefore this antibody should be checked in patients with SARS-CoV-2 associated demyelination.

show abstract

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

COVID-19, HHV6 and MOG antibody: A perfect storm

Jumah

Rahman

Figgie

et al. 2021

Journal of Neuroimmunology

View full text Add to dashboard Cite

show abstract

“…HHV-6 encephalitis after HSCT is well described, whereas myelitis is limited to case reports (Miyashita et al, 2017;Shiroshita et al, 2020). To our knowledge, HHV-6 myelitis after CAR T-cell therapy has not been reported.…”

Section: Hhv-6 Pcr On Csf (Viracormentioning

confidence: 88%

Human herpesvirus 6 myelitis after chimeric antigen receptor T-cell therapy

Handley

Khawaja

Kondapi

et al. 2021

International Journal of Infectious Diseases

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

“…20,21 Human Herpesvirus-6 HHV-6 reactivation in the posttransplant population may present with a classic limbic encephalitis, also sometimes called "posttransplant limbic encephalitis" (PALE), 22 or it may be associated with nonspecific cognitive abnormalities, delirium, 23 or myelitis. 24 PALE typically presents 2 to 6 weeks after transplantation and is often associated with amnesia, headaches, confusion, seizures, and subclinical epileptic abnormalities, 25,26 as well as either hyponatremia or, more rarely, hypernatremia. 27 Diagnosis is made via lumbar puncture with a positive HHV-6 PCR, and there is often an associated mild lymphocytic pleocytosis, although false-…”

Section: Cytomegalovirusmentioning

confidence: 99%

“…No abnormalities are typically seen on MRI of the brain or spine. 24 Some patients with HHV-6 myelitis may develop associated HHV-6 encephalitis, described in greater depth in Section "Altered Mental Status and Seizures. "…”

Section: Varicella Zoster Virusmentioning

confidence: 99%

Approach to Neurologic Complications in the Immunocompromised Patient

Vishnevetsky

Anand

2021

Semin Neurol

View full text Add to dashboard Cite

Neurologic complications are common in immunocompromised patients, including those with advanced human immunodeficiency virus, transplant recipients, and patients on immunomodulatory medications. In addition to the standard differential diagnosis, specific pathogens and other conditions unique to the immunocompromised state should be considered in the evaluation of neurologic complaints in this patient population. A thorough understanding of these considerations is critical to the inpatient neurologist in contemporary practice, as increasing numbers of patients are exposed to immunomodulatory therapies. In this review, we provide a chief complaint-based approach to the clinical presentations and diagnosis of both infectious and noninfectious complications particular to immunocompromised patients.

show abstract

Clinical characteristics of human herpesvirus-6 myelitis after allogeneic hematopoietic stem cell transplantation and its favorable outcome by early intervention

Cited by 14 publications

References 23 publications

COVID-19, HHV6 and MOG antibody: A perfect storm

COVID-19, HHV6 and MOG antibody: A perfect storm

Human herpesvirus 6 myelitis after chimeric antigen receptor T-cell therapy

Approach to Neurologic Complications in the Immunocompromised Patient

Contact Info

Product

Resources

About