Fay Alex J, Noetzel Michael J, Mar Soe S
Department of Pediatric Neurology, Washington University, St. Louis, Missouri.
Department of Pediatric Neurology, Washington University, St. Louis, Missouri.
Pediatr Neurol. 2015 Dec;53(6):523-6. doi: 10.1016/j.pediatrneurol.2015.06.016. Epub 2015 Jun 27.
Human herpesviruses-6 and -7 have been associated with febrile seizures and with encephalitis, the latter predominantly in immunocompromised individuals. Acute hemorrhagic encephalitis is frequently a fatal disease that can occur in the setting of viral infection or can be a postinfectious phenomenon, often with no cause identified. Although hemorrhagic encephalitis has been reported with human herpesvirus-6 infection, only one individual, an immunocompromised child, has been documented with human herpesvirus-7 infection. The role of immunosuppression is not well-established in the management of this rare condition.
We present an 11-year-old boy with hemorrhagic brainstem encephalitis who underwent extensive infectious and autoimmune testing, positive only for human herpesvirus-7 in the cerebrospinal fluid. The patient recovered after treatment with intravenous immunoglobulin, high-dose steroids, and plasma exchange.
This is the first report of hemorrhagic brainstem encephalitis with human herpesvirus-7 in a previously healthy individual, adding to existing reports of late-onset human herpesvirus-7 infection associated with encephalitis in children. It also underscores that aggressive immunosuppression may be used early in the course of this disorder and may be beneficial for recovery.
人类疱疹病毒6型和7型与热性惊厥及脑炎有关，后者主要发生在免疫功能低下的个体中。急性出血性脑炎通常是一种致命疾病，可发生于病毒感染的情况下，或可能是一种感染后现象，往往病因不明。虽然已有人类疱疹病毒6型感染导致出血性脑炎的报道，但仅有1例免疫功能低下儿童被记录为人类疱疹病毒7型感染。免疫抑制在这种罕见疾病的治疗中的作用尚未明确。
我们报告1例11岁患出血性脑干脑炎的男孩，其接受了广泛的感染性和自身免疫性检测，仅脑脊液中人类疱疹病毒7型呈阳性。该患者经静脉注射免疫球蛋白、大剂量类固醇和血浆置换治疗后康复。
这是首例先前健康个体感染人类疱疹病毒7型导致出血性脑干脑炎的报告，补充了儿童中与脑炎相关的迟发性人类疱疹病毒7型感染的现有报道。它还强调，在这种疾病的病程早期可积极使用免疫抑制治疗，这可能有利于康复。
