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Inherited chromosomally-integrated human herpes virus 6 confounding test results in a patient with myelitis and optic

Zhibin Tan1, Yvonne May Fen Chia2, Xiaomin Mu3

  • 1Department of Neurology, National Neuroscience Institute, Singapore; Neuroscience Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore.

Journal of Neuroimmunology
|January 7, 2024
PubMed

Insights

A rare triad of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), human herpesvirus 6 (HHV-6) reactivation, and COVID-19 infection presents unique diagnostic challenges. This case highlights a different etiological explanation for this clinical presentation.

Area of Science:

  • Neuroimmunology
  • Infectious Diseases
  • Viral Pathogenesis

Background:

  • Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an immune-mediated demyelinating condition.
  • Human herpesvirus 6 (HHV-6) reactivation can occur in immunocompromised individuals or during severe infections.
  • The interplay between MOGAD, HHV-6, and COVID-19 presents a complex clinical scenario.

Approach:

  • Case report detailing a patient with MOGAD, HHV-6 reactivation, and concurrent COVID-19 infection.
  • Comprehensive laboratory investigations including serological tests and viral load quantification.
  • Literature review to contextualize the findings within existing knowledge of MOGAD and viral infections.

Key Points:

  • The patient presented with neurological symptoms suggestive of myelitis.
  • Laboratory results indicated the presence of MOG antibodies and active HHV-6 replication.
  • COVID-19 infection was confirmed concurrently, potentially influencing the immune response.

Conclusions:

  • The observed clinical triad suggests a complex interplay between autoimmune and infectious processes.
  • Differential diagnosis is crucial, considering the potential for viral triggers or co-infections in MOGAD.
  • Further research is warranted to elucidate the precise mechanisms underlying this 'perfect storm' scenario.
Keywords:
COVID-19Chromosomally integratedHHV6Human herpes virus 6InheritedMOGMOGADMyelin oligodendrocyte glycoprotein

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