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Human herpesvirus-6 associated encephalitis with subsequent infantile spasms and cerebellar astrocytoma
H Rantala1, L Mannonen, S Ahtiluoto
1Department of Paediatrics, University of Oulu, Finland. Heikki.Rantala@oulu.fi
Insights
Human herpesvirus-6 (HHV-6) encephalitis in a child led to carditis, seizures, and a pilocytic astrocytoma. HHV-6 DNA was found in both the initial infection and the brain tumor.
Area of Science:
- Neurology
- Virology
- Pediatrics
Background:
- Human herpesvirus-6 (HHV-6) is a common viral infection in children.
- HHV-6 encephalitis can cause severe neurological complications.
- The association between HHV-6 infection and subsequent brain tumors is not well-established.
Observation:
- A 14-month-old girl presented with fever, floppiness, and rash, progressing to encephalitis, carditis, and intractable seizures.
- Cerebrospinal fluid tested positive for HHV-6 DNA via PCR on two separate occasions.
- The patient developed infantile spasms and significant developmental regression.
- An MRI revealed a pilocytic astrocytoma 11 months after initial symptom onset.
Findings:
- HHV-6 DNA was detected in the patient's cerebrospinal fluid and the surgically removed pilocytic astrocytoma.
- This case represents the first documented instance of HHV-6 encephalitis with carditis, infantile spasms, and a concurrent brain tumor harboring the virus.
Implications:
- HHV-6 may play a role in the pathogenesis of certain pediatric brain tumors.
- Further research is needed to explore the potential oncogenic properties of HHV-6.
- This case highlights the importance of considering HHV-6 in the differential diagnosis of unexplained encephalitis and neurological disorders in children.
Abstract:
A 14-month-old girl presented after 3 days of fever, floppiness, and diffuse urticarial exanthem. She developed encephalitis and carditis and 1 week later, intractable seizures. Initial CT and MRI showed no changes in the brain parenchyma. On days 14 and 34 after the onset of symptoms, a human herpesvirus-6 (HHV-6) genome in cerebrospinal fluid was identified by polymerase chain reaction (PCR). Convulsions became more frequent and 11 weeks from the onset, they changed to typical infantile spasms with hypsarrhythmic electroencephalogram. She gradually lost her social contact and ability to walk and sit. Eleven months after the primary infection, a repeated MRI of the brain revealed a cystic tumour of 2 cm in diameter near the vermis. The tumour was surgically removed, and shown to be a pilocytic astrocytoma on histopathological examination. HHV-6 DNA was detected by PCR in new tumour tissue. This is the first reported case of HHV-6 encephalitis associated with carditis, infantile spasms, and a subsequent brain tumour containing the HHV-6 genome.