Kuribayashi Kageaki, Matsunaga Takuya, Iyama Satoshi, Takada Koichi, Sato Tsutomu, Murase Kazuyuki, Fujimi Akihito, Takimoto Rishu, Kawanishi Johji, Niitsu Yoshiro
Fourth Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo.
Intern Med. 2006;45(7):475-8. doi: 10.2169/internalmedicine.45.1507. Epub 2006 May 1.
A 31-year-old man referred to our hospital for treatment of his chronic myeloid leukemia (CML) in the first chronic phase by bone marrow transplantation. We pretreated him with cyclophosphamide and total body irradiation and bone marrow transplantation (BMT) was carried out. On day 31, the engraftment was confirmed and on day 52, acute graft versus host disease (GVHD) was observed. On day 189, he lost consciousness due to cyclosporine A-induced leukoencephalopathy and 375 mg cyclosporine A was changed to 100 mg prednisolone. On day 199, liver dysfunction (AST 410 IU/L, ALT 557 IU/L, gammaGTP 385 IU/L, ALP 363 IU/L, D-Bil 0.3 mg/dl) developed and a liver biopsy was performed. PCR analysis of DNA from the liver biopsy specimen was positive for HHV-6 and immunostaining using anti-HHV-6 and anti-HHV-6b antibodies showed positive staining in the cytosol of hepatocytes. No other viruses were found to induce hepatitis. From these results, he was diagnosed as having HHV-6 hepatitis and it was successfully treated with gancyclovir (GCV) administration.
一名31岁男性因处于慢性髓性白血病（CML）慢性期而转诊至我院接受骨髓移植治疗。我们先用环磷酰胺和全身照射对他进行预处理，然后进行了骨髓移植（BMT）。在第31天确认植入成功，第52天观察到急性移植物抗宿主病（GVHD）。在第189天，他因环孢素A诱导的白质脑病而失去意识，环孢素A的剂量从375毫克改为100毫克泼尼松龙。在第199天，出现肝功能障碍（谷草转氨酶410国际单位/升，谷丙转氨酶557国际单位/升，γ-谷氨酰转肽酶385国际单位/升，碱性磷酸酶363国际单位/升，直接胆红素0.3毫克/分升），并进行了肝脏活检。肝脏活检标本的DNA的PCR分析显示人疱疹病毒6型（HHV-6）呈阳性，使用抗HHV-6和抗HHV-6b抗体的免疫染色显示在肝细胞胞质溶胶中呈阳性染色。未发现其他病毒引起肝炎。根据这些结果，他被诊断为HHV-6肝炎，并通过给予更昔洛韦（GCV）成功治愈。
