Dement Neurocogn Disord.  2016 Sep;15(3):88-91. 10.12779/dnd.2016.15.3.88.

Human Herpes Virus 6 Encephalitis Following Bone Marrow Transplantation with Uncommon Magnetic Resonance Imaging Findings

• Hwang J
• Kim JE
• Roh JH
• Lee JH

• KMID: 2442851
• DOI: http://doi.org/10.12779/dnd.2016.15.3.88

Abstract

BACKGROUND
Human Herpes Virus 6 (HHV6) is commonly associated with encephalitis following bone marrow transplantation. However, hippocampal atrophy and global hypometabolism are rare findings in HHV6 encephalitis.
CASE REPORT
A 41-year-old right-handed woman with acute lymphoblastic leukemia presented with fever and mental changes 2 weeks after receiving a sibling bone marrow transplant. The patient's cerebrospinal fluid (CSF) was positive for HHV-6 deoxyribonucleic acid (DNA), but was negative for other viral DNA. Brain magnetic resonance imaging revealed atrophic changes in bilateral medial temporal lobes. Following 4 weeks of ganciclovir therapy, a CSF exam was negative for HHV-6 DNA and the patient's neurological symptoms partially improved. However, she was disoriented and had severe retrograde and anterograde amnesia. 18F-fluorodeoxyglucose-positron emission tomography indicated global hypometabolism in the medial temporal lobes and the fronto-parietal cortices.
CONCLUSIONS
This is a rare and unusual case of hippocampal atrophy in the acute stage of HHV6 encephalitis. Our imaging findings may reflect the chronic indolent course of HHV6 encephalitis.

Keyword

herpes; human herpes virus; Human Herpes Virus 6 encephalitis; limbic encephalitis; retrograde amnesia; anterograde amnesia

MeSH Terms

Adult
Amnesia, Anterograde
Amnesia, Retrograde
Atrophy
Bone Marrow Transplantation*
Bone Marrow*
Brain
Cerebrospinal Fluid
DNA
DNA, Viral
Encephalitis*
Female
Fever
Ganciclovir
Herpesvirus 6, Human
Humans*
Limbic Encephalitis
Magnetic Resonance Imaging*
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Siblings
Temporal Lobe
DNA
DNA, Viral
Ganciclovir

Figure

• 

  Fig. 1 Brain MR images in the patient. A: An axial fluid-attenuated inversion recovery image demonstrates an atrophic change in the bilateral medial temporal lobes without abnormal high signal intensity. B: A coronal contrast-enhanced T1-weighted image shows an atrophic change in the bilateral medial temporal lobes without leptomeningeal enhancement. MR: magnetic resonance.

• 

  Fig. 2 18F-Fludeoxyglucose-PET performed 8 weeks after transplantation shows global hypometabolism in the bilateral medial temporal lobes and the fronto-parietal cortices. A: Hypometabolism in fronto-parietal cortices. B: Hypometabolism in bilateral medial temporal lobes. PET: positron emission tomography.

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