Challenging complications of treatment – human herpes virus 6 encephalitis and pneumonitis in a patient undergoing autologous stem cell transplantation for relapsed Hodgkin's disease: a case report
© Bommer et al; licensee BioMed Central Ltd. 2009
Received: 18 April 2009
Accepted: 20 July 2009
Published: 20 July 2009
Reactivation of human herpesvirus 6 (HHV-6) occurs frequently in patients after allogeneic stem cell transplantation and is associated with bone-marrow suppression, enteritis, pneumonitis, pericarditis and also encephalitis. After autologous stem cell transplantation or intensive polychemotherapy HHV-6 reactivation is rarely reported.
This case demonstrates a severe symptomatic HHV-6 infection with encephalitis and pneumonitis after autologous stem cell transplantation of a patient with relapsed Hodgkin's disease.
Careful diagnostic work up in patients with severe complications after autologous stem cell transplantation is mandatory to identify uncommon infections.
Viruses that belong to the herpes group such as HSV1/2, HHV6 and CMV are known to reactivate after intensive immunosuppressive treatment. In patients receiving allogeneic stem cell transplantation reactivations are frequently reported [1–3]. Several reports showed a broad variety of clinical manifestation, ranging from asymptomatic reactivation, delayed hematopoietic recovery up to severe systemic infection with pneumonia and encephalitis [4–8]. Reports with severe HHV6 associated complications are limited to patients receiving allogeneic transplantation or – in the autologous setting – to paediatric patients . Reports of severe complications caused by HHV6 after autologous stem cell transplantation or after intensive chemotherapeutic treatments are very rare due to infrequent events, but maybe also seldom due to lack of specific diagnostic approaches.
Diagnosis of HHV6 Infection remains basically PCR-based with detection of viral DNA in blood, cerebrospinal fluid and bronchoalveolar lavage . Recently evidence for integration of HHV6B-DNA in leukocytes without any clinical relevance was reported, arousing doubts about unjustified diagnosis and treatment of HHV6 infection in transplant recipients.
We report an extremely uncommon infectious complication in a patient with relapsed Hodgkin's disease. Whereas asymptomatic HHV6 reactivation is frequently reported in patients after allogeneic stem cell transplantation, severe disease is rare in patients after autologous stem cell transplantation. Nevertheless, in patients with severe complications of infections after autologous stem cell transplantation or intensive chemotherapeutic treatment, HHV-6 detection should be included into the diagnostic work-up for these patients and longitudinal observational clinical studies have to be performed to examine the frequency of clinically relevant HHV-6 infections in these patient cohorts.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
G.J. and B.M. are attending physicians in the department of hematology and oncology of the University of Ulm
P.S. is attending physician in the department of Diagnostic and Interventional Radiology of the University of Ulm
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