Diagnostic Clues to Human Herpesvirus 6 Encephalitis and Wernicke Encephalopathy After Pediatric Hematopoietic Cell Transplantation.
Diagnostic Clues to Human Herpesvirus 6 Encephalitis and Wernicke Encephalopathy After Pediatric Hematopoietic Cell Transplantation.
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DOI：
10.1177/0883073814560628
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发表时间：
2015-09
影响因子：
1.9
通讯作者：
Pillai A
中科院分区：
文献类型：
--
作者：
Sadighi Z;Sabin ND;Hayden R;Stewart E;Pillai A
人类疱疹病毒6型（HHV6）脑炎和韦尼克脑病是可治疗的，但经常未诊断的原因，脑病的儿童接受异基因和自体造血细胞移植。在这里，我们回顾了这两种情况的代表性病例，以突出具体的和相关的神经功能，促使有效的诊断和治疗。2例伴有癫痫发作、记忆改变或特异性幻视和脑脊液PCR检测到HHV 6的意识模糊患者，经更昔洛韦或膦甲酸治疗后病毒载量有所改善。2例患者出现意识模糊、共济失调或眼部变化和血清硫胺素水平低，经胃肠外硫胺素治疗后消退。在所有病例中，明确的诊断和治疗是通过高度怀疑和寻找伴随意识模糊状态的特异性神经功能缺损来实现的。在临床上将这两种情况与移植后发生的其他常见神经系统综合征区分开来是至关重要的，从而通过及时诊断和有效治疗可能改善患者的预后。
Human herpesvirus 6 (HHV6) encephalitis and Wernicke’s encephalopathy are treatable yet frequently undiagnosed causes of encephalopathy in pediatric recipients of allogeneic and autologous hematopoietic cell transplantation. Here we review representative cases of both conditions to highlight specific and relevant neurologic features which prompted effective diagnosis and treatment. Two patients with confusion accompanied by seizures, memory changes, or specific visual hallucinations and HHV6 detectable by PCR in cerebrospinal fluid had improvement in viral load with ganciclovir or foscarnet treatment. Two patients had confusion, ataxia, or ocular changes and low serum thiamine levels, which resolved with parenteral thiamine. In all cases, definitive diagnosis and treatment were facilitated by a high index of suspicion and search for specific pathognomonic neurologic deficits accompanying the confusional state. It is critical to clinically differentiate these two conditions from other common neurologic syndromes occurring after transplant, allowing potentially improved patient outcomes by prompt diagnosis, and effective treatment.