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Primary Human Herpes Virus-6 Causing Recalcitrant Pyrexia after Pilocytic Astrocytoma Resection

Julie L Chan1, Peyton Nisson1, Moise Danielpour1

  • 1Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Pediatric Neurosurgery
|March 26, 2023
PubMed

Insights

Human herpes virus-6 (HHV-6) infection was identified in a pediatric patient with persistent fever after brain surgery. Early detection via the FilmArray Meningitis/Encephalitis panel enabled prompt antiviral treatment, improving outcomes.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Pediatric Neurology

Background:

  • Human herpes virus-6 (HHV-6) commonly affects the pediatric central nervous system.
  • HHV-6 is often overlooked as a cause of CSF pleocytosis post-neurosurgery.
  • Timely diagnosis of HHV-6 infection is crucial for effective management.

Observation:

  • A 2-year-old girl presented with neurological symptoms and persistent fever after brain tumor resection and hydrocephalus treatment.
  • The patient experienced prolonged fever and worsening CSF leukocytosis despite broad-spectrum antibiotics.
  • The FilmArray Meningitis/Encephalitis (FAME) panel detected HHV-6, leading to a diagnosis of HHV-6-induced meningitis.

Findings:

  • This is the first reported case of HHV-6 infection diagnosed by FAME after intracranial tumor resection.
  • Pathological analysis excluded HHV-6 in the brain tumor tissue, suggesting a primary peripheral infection.
  • Antiviral treatment led to improved CSF leukocytosis and reduced fever, confirming HHV-6 as the causative agent.

Implications:

  • Early identification of HHV-6 can guide treatment decisions and reduce unnecessary antibiotic use.
  • A modified algorithm for persistent fever post-neurosurgery may improve patient outcomes.
  • This case highlights the importance of considering HHV-6 in post-craniotomy fever evaluations.
Abstract

Keywords:
Human herpes virus-6Pilocytic astrocytomaPostoperative feverPostoperative infectionPrimary viral infection

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