Variant B human herpesvirus-6 associated febrile dermatosis with thrombocytopenia and encephalopathy in a liver transplant recipient.
Variant B human herpesvirus-6 associated febrile dermatosis with thrombocytopenia and encephalopathy in a liver transplant recipient.
复制标题
人类疱疹病毒 6 变体 B 与肝移植受者的发热性皮肤病、血小板减少症和脑病相关。
作者：
Nina Singh;D. Carrigan;T. Gayowski;Jagjit Singh;I. Marino
人疱疹病毒6 （HHV-6）是最近发现的一种病毒，其在实体器官移植受者中的致病性尚未确定。我们描述了一个独特的发热综合征，由于播散侵袭变异型乙型HHV-6感染在肝移植受者与证据直接组织入侵的病毒。以危及生命的血小板减少、进行性脑病和皮疹为特征的急性发热性疾病在肝移植受者中与侵袭性HHV-6感染有关。在细胞培养中从患者外周血中分离HHV-6；在患者外周血单个核细胞（PBMC）中检测到变异乙型HHV-6 DNA，浓度大于每10(6)个PBMC 1000个病毒基因组。骨髓活检对HHV-6也呈阳性，记录了直接的组织入侵。静脉注射更昔洛韦三周后，临床反应迅速。虽然需要进行更大规模的研究，但我们的病例表明，在发热、细胞减少和脑病患者的诊断评估中应考虑HHV-6，特别是因为HHV-6对更昔洛韦和氟猩红敏感。
Human herpesvirus 6 (HHV-6) is a recently discovered virus the pathogenicity of which in solid organ transplant recipients has not been defined. We describe a unique febrile syndrome due to disseminated invasive variant B HHV-6 infection in a liver transplant recipient with evidence of direct tissue invasion by the virus. Acute febrile illness characterized by life-threatening thrombocytopenia, progressive encephalopathy and skin rash developed in association with invasive HHV-6 infection in a liver transplant recipient. HHV-6 was isolated from the patient's peripheral blood in cell culture; variant B HHV-6 DNA was detected in the patient's peripheral blood mononuclear cells (PBMC) at a concentration greater than 1000 virus genomes per 10(6) PBMC. A bone marrow biopsy was also positive for HHV-6, documenting direct tissue invasion. Intravenous ganciclovir for three weeks led to a prompt clinical response. Although larger studies are warranted, our case suggests that HHV-6 should be considered in the diagnostic evaluation of patients with fever, cytopenia, and encephalopathy, particularly since HHV-6 is susceptible to ganciclovir and foscarnet.