Volume 12 Issue 4
Jul.  2021
Turn off MathJax
Article Contents
Article Navigation >  ORGAN TRANSPLANTATION  > 2021  >  12(4): 465-471
Guo Yafei, Wang Jizhou, Zhu Zebin, et al. Multi-disciplinary team of human herpes virus-6B encephalitis after liver transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(4): 465-471. doi: 10.3969/j.issn.1674-7445.2021.04.014
Citation: Guo Yafei, Wang Jizhou, Zhu Zebin, et al. Multi-disciplinary team of human herpes virus-6B encephalitis after liver transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(4): 465-471. doi: 10.3969/j.issn.1674-7445.2021.04.014
shu

Multi-disciplinary team of human herpes virus-6B encephalitis after liver transplantation

doi: 10.3969/j.issn.1674-7445.2021.04.014

  • Organ Transplantation Center, the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), Hefei 230036, China

More Information
  • Corresponding author: Huang Dehao, Email: zssyhdh@126.com
  • Received Date: 2021-03-23
    Available Online: 2021-07-13
  • Publish Date: 2021-07-15
    Abstract
  •   Objective  To evaluate the role of multi-disciplinary team (MDT) in improving the diagnosis and treatment of human herpes virus-6B (HHV-6B) encephalitis after liver transplantation.  Methods  MDT consultation was delivered for one rare case of HHV-6B encephalitis after liver transplantation to establish an effective individualized treatment regime.  Results  On the 16 d after liver transplantation, the patient developed headache, and suddenly presented with unresponsiveness, unconsciousness, coma complicated with involuntary limb twitching on the 18 d. Blood ammonia level was increased. Brain CT scan showed cerebral ischemic changes. Electroencephalography prompted the epileptic seizure. After MDT consultation, the possibility of nervous system infection after liver transplantation was considered, and medication therapy was given to control the epileptic seizure. Cerebrospinal fluid examination via lumbar puncture hinted increased intracranial pressure. Real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) of the cerebrospinal fluid demonstrated that the patient was tested positive for HHV-6B nucleic acid, which confirmed the diagnosis of HHV-6B encephalitis. The immunosuppressant regime was adjusted, intravenous ganciclovir was given for antiviral treatment, and active interventions were delivered to prevent and treat relevant complications. Epileptic seizure disappeared after 4 d, and neurological symptoms were significantly alleviated after 2 weeks. After 4-week antiviral treatment, the patient was tested negative for virology testing, and the neurological function was restored to normal.  Conclusions  HHV-6B encephalitis rarely occurs after adult liver transplantation, which is primarily associated with the virus reactivation after use of immunosuppressant. MDT pattern may be employed to deepen the understanding of the patient's condition, formulate more effective individualized treatment regime, and enhance the clinical efficacy and safety.

     

    • FullText(HTML)
  • loading
    • References(32)
  • [1]
    PIZZI M, NG L. Neurologic complications of solid organ transplantation[J]. Neurol Clin, 2017, 35(4): 809-823. DOI: 10.1016/j.ncl.2017.06.013.
    [2]
    LIPOWSKI D, POPIEL M, PERLEJEWSKI K, et al. A cluster of fatal tick-borne encephalitis virus infection in organ transplant setting[J]. J Infect Dis, 2017, 215(6): 896-901. DOI: 10.1093/infdis/jix040.
    [3]
    POUCH SM, KATUGAHA SB, SHIEH WJ, et al. Transmission of eastern equine encephalitis virus from an organ donor to 3 transplant recipients[J]. Clin Infect Dis, 2019, 69(3): 450-458. DOI: 10.1093/cid/ciy923.
    [4]
    SCHLOTTAU K, FORTH L, ANGSTWURM K, et al. Fatal encephalitic borna disease virus 1 in solid-organ transplant recipients[J]. N Engl J Med, 2018, 379(14): 1377-1379. DOI: 10.1056/NEJMc1803115.
    [5]
    QI ZL, SUN LY, BAI J, et al. Japanese encephalitis following liver transplantation: a rare case report[J]. World J Clin Cases, 2020, 8(2): 337-342. DOI: 10.12998/wjcc.v8.i2.337.
    [6]
    BONNAFOUS P, MARLET J, BOUVET D, et al. Fatal outcome after reactivation of inherited chromosomally integrated HHV-6A (iciHHV-6A) transmitted through liver transplantation[J]. Am J Transplant, 2018, 18(6): 1548-1551. DOI: 10.1111/ajt.14657.
    [7]
    罗静, 程翼飞, 闫晨华, 等. 儿童单倍型造血干细胞移植后HHV-6病毒性脑炎二例报告并文献复习[J]. 中华血液学杂志, 2019, 40(2): 152-155. DOI: 10.3760/cma.j.issn.0253-2727.2019.02.012.

    LUO J, CHENG YF, YAN CH, et al. HHV-6 viral encephalitis after allogeneic hematopoietic stem cell transplantation in children: two cases report and literature review[J]. Chin J Hematol, 2019, 40(2): 152-155. DOI: 10.3760/cma.j.issn.0253-2727.2019.02.012.
    [8]
    AGUT H, BONNAFOUS P, GAUTHERET-DEJEAN A. Laboratory and clinical aspects of human herpesvirus 6 infections[J]. Clin Microbiol Rev, 2015, 28(2): 313-335. DOI: 10.1128/CMR.00122-14.
    [9]
    ELIASSEN E, HEMOND CC, SANTORO JD. HHV-6-associated neurological disease in children: epidemiologic, clinical, diagnostic, and treatment considerations[J]. Pediatr Neurol, 2020, 105: 10-20. DOI: 10.1016/j.pediatrneurol.2019.10.004.
    [10]
    YLINEN E, LEHTINEN S, JAHNUKAINEN T, et al. Human herpes virus 6 infection in pediatric organ transplant patients[J]. Pediatr Transplant, 2017, 21(4). DOI: 10.1111/petr.12905.
    [11]
    FERNÁNDEZ-RUIZ M, KUMAR D, HUSAIN S, et al. Utility of a monitoring strategy for human herpesviruses 6 and 7 viremia after liver transplantation: a randomized clinical trial[J]. Transplantation, 2015, 99(1): 106-113. DOI: 10.1097/TP.0000000000000306.
    [12]
    PELLETT MADAN R, HAND J, AST Infectious Diseases Community of Practice. Human herpesvirus 6, 7, and 8 in solid organ transplantation: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice[J]. Clin Transplant, 2019, 33(9): e13518. DOI: 10.1111/ctr.13518.
    [13]
    YASUI T, SUZUKI T, YOSHIKAWA T, et al. Clinical course of human herpesvirus 6 infection in pediatric living donor liver transplantation[J]. Pediatr Transplant, 2018, 22(7): e13239. DOI: 10.1111/petr.13239.
    [14]
    INUI Y, YAKUSHIJIN K, OKAMURA A, et al. Human herpesvirus 6 encephalitis in patients administered mycophenolate mofetil as prophylaxis for graft-versus-host disease after allogeneic hematopoietic stem cell transplantation[J]. Transpl Infect Dis, 2019, 21(1): e13024. DOI: 10.1111/tid.13024.
    [15]
    MIYASHITA N, ENDO T, ONOZAWA M, et al. Risk factors of human herpesvirus 6 encephalitis/myelitis after allogeneic hematopoietic stem cell transplantation[J]. Transpl Infect Dis, 2017, 19(3): e12682. DOI: 10.1111/tid.12682.
    [16]
    RAUBER C, BARTELHEIMER K, ZHOU T, et al. Prevalence of human herpesviruses in biliary fluid and their association with biliary complications after liver transplantation[J]. BMC Gastroenterol, 2019, 19(1): 110. DOI: 10.1186/s12876-019-1033-x.
    [17]
    FIDA M, HAMDI AM, BRYSON A, et al. Long-term outcomes of patients with human herpesvirus 6 encephalitis[J]. Open Forum Infect Dis, 2019, 6(7): ofz269. DOI: 10.1093/ofid/ofz269.
    [18]
    VICTORIA NC, PHAN TL, AGARWAL KA. A systematic review of sodium disorders in HHV-6 encephalitis[J]. Biol Blood Marrow Transplant, 2020, 26(5): 1034-1039. DOI: 10.1016/j.bbmt.2020.01.023.
    [19]
    WARD KN, HILL JA, HUBACEK P, et al. Guidelines from the 2017 European conference on infections in leukaemia for management of HHV-6 infection in patients with hematologic malignancies and after hematopoietic stem cell transplantation[J]. Haematologica, 2019, 104(11): 2155-2163. DOI: 10.3324/haematol.2019.223073.
    [20]
    ABU SITTA E, KHAZAN A, LUTTMANN K, et al. HHV-6: an unusual cause of cerebellar ataxia[J]. BMJ Case Rep, 2020, 13(3): e234303. DOI: 10.1136/bcr-2020-234303.
    [21]
    CAMUS V, BOUWYN JP, CHAMSEDDINE A, et al. Human herpesvirus-6 acute limbic encephalitis after unrelated umbilical cord blood transplantation successfully treated with ganciclovir[J]. Bone Marrow Transplant, 2015, 50(10): 1385-1387. DOI: 10.1038/bmt.2015.159.
    [22]
    AGNIHOTRI SP. Central nervous system opportunistic infections[J]. Semin Neurol, 2019, 39(3): 383-390. DOI: 10.1055/s-0039-1687842.
    [23]
    OGATA M, UCHIDA N, FUKUDA T, et al. Clinical practice recommendations for the diagnosis and management of human herpesvirus-6B encephalitis after allogeneic hematopoietic stem cell transplantation: the Japan Society for Hematopoietic Cell Transplantation[J]. Bone Marrow Transplant, 2020, 55(6): 1004-1013. DOI: 10.1038/s41409-019-0752-5.
    [24]
    OGATA M, PHAN TL, FUKUDA T. Antiviral therapy for the treatment of HHV-6-associated syndromes after transplant[J]. Am J Transplant, 2019, 19(1): 306-307. DOI: 10.1111/ajt.15069.
    [25]
    ONGRÁDI J, ABLASHI DV, YOSHIKAWA T, et al. Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals[J]. J Neurovirol, 2017, 23(1): 1-19. DOI: 10.1007/s13365-016-0473-0.
    [26]
    CHEMALY RF, HILL JA, VOIGT S, et al. In vitro comparison of currently available and investigational antiviral agents against pathogenic human double-stranded DNA viruses: a systematic literature review[J]. Antiviral Res, 2019, 163: 50-58. DOI: 10.1016/j.antiviral.2019.01.008.
    [27]
    TOOMEY D, PHAN TL, NGUYEN V, et al. Retrospective case analysis of antiviral therapies for HHV-6 encephalitis after hematopoietic stem cell transplantation[J]. Transpl Infect Dis, 2021, 23(1): e13443. DOI: 10.1111/tid.13443.
    [28]
    RIGHI E, CARNELUTTI A, MUSER D, et al. Successful treatment and FDG-PET/CT monitoring of HHV-6 encephalitis in a non-neutropenic patient: case report and literature review[J]. J Neurovirol, 2017, 23(6): 908-912. DOI: 10.1007/s13365-017-0566-4.
    [29]
    HOERSTER K, UHRBERG M, WIEK C, et al. HLA class I knockout converts allogeneic primary NK cells into suitable effectors for "Off-the-Shelf" immunotherapy[J]. Front Immunol, 2021, 11: 586168. DOI: 10.3389/fimmu.2020.586168.
    [30]
    TZANNOU I, PAPADOPOULOU A, NAIK S, et al. Off-the-shelf virus-specific T cells to treat BK virus, human herpesvirus 6, cytomegalovirus, Epstein-Barr virus, and adenovirus infections after allogeneic hematopoietic stem-cell transplantation[J]. J Clin Oncol, 2017, 35(31): 3547-3557. DOI: 10.1200/JCO.2017.73.0655.
    [31]
    HILL JA, NICHOLS WG, MARTY FM, et al. Oral brincidofovir decreases the incidence of HHV-6B viremia after allogeneic HCT[J]. Blood, 2020, 135(17): 1447-1451. DOI: 10.1182/blood.2019004315.
    [32]
    OGATA M, TAKANO K, MORIUCHI Y, et al. Effects of prophylactic foscarnet on human herpesvirus-6 reactivation and encephalitis in cord blood transplant recipients: a prospective multicenter trial with an historical control group[J]. Biol Blood Marrow Transplant, 2018, 24(6): 1264-1273. DOI: 10.1016/j.bbmt.2018.02.008.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (363) PDF downloads(46) Cited by()
    Proportional views
    Related

    WeChat Subscription Account

    Wechat Service Account

    Contact Us
    • Tel：020-38736410
    • Email: organtranspl@163.com
    • Address：The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou
    • Editorial Office of Organ Transplantation  粤ICP备2021030844号
    Links

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return