Deborska-Materkowska Dominika, Sadowska Anna, Matłosz Bartłomiej, Zegarska Jolanta, Durlik Magdalena
Klinika Medycyny Transplantacyjnej i Nefrologii, Instytut Transplantologii AM w Warszawie.
Przegl Epidemiol. 2006;60(1):141-6.
Human herpesvirus 6 (HHV-6) is a lymphotropic herpesvirus of emerging clinical significance in immunocompromised patients. Little is known about clinical impact and relevance of HHV-6 variant A infection in renal transplant recipients. We describe the case of a 44-year-old woman who underwent second allogenic kidney transplantation (Tx). On day 6 after Tx she presented with high fever. She developed thrombocytopenia, anemia, diarrhea, liver dysfunction and graft failure. Renal graft biopsies that followed revealed acute rejection. Apart from the introduction of anti-rejection therapy, empiric gancyclovir, as well as antibacterial treatment was initiated. To determine the serostatus of HHV-6 and load of HHV-6A and -6B DNA in paired sera samples an enzyme-linked immunosorbent assay, indirect immunofluorescence assay and real time quantitative polymerase chain reaction (PCR) assay based on the exonuclease format (TaqMan) was devised. HHV-6A was the sole pathogen, the DNA of which was retrospectively detected in patient's serum. HHV-6 IgM seroconversion was demonstrated. No other viral (e.g. cytomegalovirus (CMV)) or other pathogens were detected in the blood, urine, and stool. Following therapy with gancyclovir, viral load declined to undetectable levels. Gradual improvement in clinical status of the patient was observed. HHV-6 infection may be associated with specific clinical manifestations and should be considered in a transplant recipient who presents with a clinical syndrome resembling CMV infection, where CMV assays are negative. This case confirm symptomatic HHV-6 infection and suggests that HHV-6 variant A reactivation may potentially trigger graft rejection.
人疱疹病毒6型（HHV-6）是一种嗜淋巴细胞性疱疹病毒，在免疫功能低下的患者中具有新出现的临床意义。关于HHV-6 A型感染在肾移植受者中的临床影响和相关性知之甚少。我们描述了一名44岁女性接受第二次同种异体肾移植（Tx）的病例。肾移植术后第6天，她出现高热。她出现了血小板减少、贫血、腹泻、肝功能障碍和移植失败。随后的肾移植活检显示为急性排斥反应。除了开始抗排斥治疗外，还开始经验性使用更昔洛韦以及抗菌治疗。为了确定成对血清样本中HHV-6的血清状态以及HHV-6 A和-6B DNA的载量，设计了一种基于核酸外切酶形式（TaqMan）的酶联免疫吸附测定、间接免疫荧光测定和实时定量聚合酶链反应（PCR）测定。HHV-6 A型是唯一的病原体，其DNA在患者血清中被回顾性检测到。证实了HHV-6 IgM血清学转换。在血液、尿液和粪便中未检测到其他病毒（如巨细胞病毒（CMV））或其他病原体。使用更昔洛韦治疗后，病毒载量降至检测不到的水平。观察到患者的临床状态逐渐改善。HHV-6感染可能与特定的临床表现相关，对于出现类似CMV感染临床综合征但CMV检测为阴性的移植受者应予以考虑。该病例证实了有症状的HHV-6感染，并提示HHV-6 A型再激活可能潜在地引发移植排斥反应。
