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Acute encephalopathy and status epilepticus associated with human herpes virus 6 infection
C M Jones1, H G Dunn, E E Thomas
1Division of Infectious Diseases, British Columbia's Children's Hospital, Vancouver, Canada.
Insights
Human herpes virus 6 (HHV-6) infection can cause febrile status epilepticus in young children. This case highlights the importance of considering HHV-6 in pediatric encephalopathy with seizures.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Virology
Background:
- Febrile status epilepticus (FSE) is a medical emergency in infants and young children.
- Encephalopathy can be a serious complication of FSE.
- Human herpes virus 6 (HHV-6) is a common viral pathogen in young children.
Observation:
- A previously healthy 22-month-old boy presented with FSE, high fever, and coma.
- Seizures resolved with anticonvulsants, and fever normalized within 24 hours.
- The child developed a rash consistent with roseola infantum on day three.
Findings:
- Acute HHV-6 infection was confirmed serologically.
- HHV-6 DNA was initially undetectable in CSF and serum but later found in saliva.
- The patient experienced a slow recovery from encephalopathy.
Implications:
- HHV-6 infection should be considered in the differential diagnosis of FSE in infants and young children.
- Understanding the pathogenesis of HHV-6-associated encephalopathy is crucial for clinical management.
- Early diagnosis and consideration of viral etiologies can guide treatment and improve outcomes.
Abstract:
A previously healthy 22-month-old boy presented in status epilepticus with high fever. He was comatose, with upper respiratory-tract infection. The seizures responded to anticonvulsant therapy. The boy's temperature returned to normal within 24 hours and he recovered slowly from his encephalopathy. On the third hospital day, he exhibited the characteristic rash of reseola infantum. Acute infection with human herpes virus 6 (HHV-6) was established serologically by enzyme immunoassay. HHV-6 DNA was not detected by polymerase chain reaction in CSF or serum at the onset of illness, but was found three months later in the child's saliva. The pathogenesis of the patient's encephalopathy is discussed. It is concluded that HHV-6 infection should be considered in infants and young children with febrile status epilepticus.