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Published on: April 2, 2012
Human herpesvirus-6 (HHV-6)-associated necrotizing encephalitis in Griscelli's syndrome
M Wagner1, J Müller-Berghaus, R Schroeder
1Department of Pathology, University of Cologne Medical School, Germany.
Abstract:
We report a male caucasian German pediatric patient of no Arab or Mediterranean ancestry with virus associated CNS lesions in Griscelli's syndrome (GS; McKusick No. 214450). The boy presented with recurrent infections, and meningitis with subsequent progressive signs of increased intracranial pressure leading to death at 32 weeks of age. At autopsy, various sites of the CNS revealed necroses in gray and white matter. CNS histology revealed numerous and massive predominantly perivascular CD8 positive lymphohistiocytic infiltrates. These findings were associated strictly with the presence of human herpesvirus-6 (HHV-6) genome or the HHV-6 specific late antigen H-AR 3, found in neurons, oligodendrocytes, and astrocytes. The search for HHV-6 replication dependent antigen, HHV-7 DNA, CMV, adenovirus, Coxsackie B1, B2, and B4-antigens, and mycobacteria was not successful. Detection of viruses was attempted using immunohistochemistry, in situ hybridization or nested polymerase chain reaction, respectively. Lymphocyte typing was carried out immunohistochemically. In GS, virus induced CNS damage does not seem to require necessarily active virus replication. It may also appear as a consequence of an immune reaction triggered by antigen expression.
Insights
This study details a pediatric case of Griscelli's syndrome (GS) with severe central nervous system (CNS) damage. Human herpesvirus-6 (HHV-6) was identified as a key factor in the virus-associated CNS lesions.
Area of Science:
- Neurology
- Virology
- Pediatrics
Background:
- Griscelli's syndrome (GS) is a rare genetic disorder.
- GS is characterized by pigmentary dilution, neurological deficits, and immunodeficiency.
- Virus-associated central nervous system (CNS) lesions are a severe complication.
Observation:
- A pediatric patient with GS presented with recurrent infections and meningitis.
- The patient exhibited progressive signs of increased intracranial pressure, leading to death at 32 weeks.
- Autopsy revealed CNS necroses and predominantly perivascular CD8 positive lymphohistiocytic infiltrates.
Findings:
- Human herpesvirus-6 (HHV-6) genome and specific late antigen (H-AR 3) were detected in neurons, oligodendrocytes, and astrocytes.
- The presence of HHV-6 was strictly associated with CNS lesions.
- Other viruses and mycobacteria were not detected, suggesting a specific role for HHV-6.
Implications:
- Virus-induced CNS damage in GS may not require active viral replication.
- Immune reactions triggered by viral antigen expression could cause significant neurological damage.
- This highlights the complex interplay between viral presence and host immune response in GS pathogenesis.
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