Escobar-Villalba Alfonso, Sainz de la Maza Susana, Pérez Torre Paula, Galán Juan Carlos, Rodríguez-Domínguez Mario, Monreal Laguillo Enric, Martínez Ulloa Pedro Luis, Buisán Catevilla Javier, Corral Iñigo
Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain.
Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain.
J Clin Virol. 2016 Apr;77:63-5. doi: 10.1016/j.jcv.2016.02.001. Epub 2016 Feb 11.
HHV7 reactivation has been occasionally reported as a cause of encephalitis or myelitis in transplant recipients, but to our knowledge it has never been associated with neurological disease in HIV-infected patients. We report a case of acute myelitis in an HIV-infected patient, with sustained HHV-7 DNA amplification in cerebrospinal fluid (CSF) and a favourable response to foscarnet.
A 40 year-old man with HIV infection was admitted with asymmetric hypoesthesia in legs and paraparesis. He was receiving treatment with efavirenz, emtricitabine and tenofovir, his CD4 count was 580/mm3 and HIV viral load was undetectable. Magnetic resonance imaging showed a focal central hyperintensity on T2 and STIR sequences, on the torathic spinal cord, with slight enhancement after intravenous gadolinium. All microbiological studies were negative except for HHV-7 DNA amplification in CSF. With a diagnosis of idiopathic transverse myelitis, treatment with high-dose intravenous methylprednisolone was initiated. However, paraparesis continued worsening, and a second CSF obtained 12 days after the first one resulted again in HHV-7 amplification.
The patient was treated with a 2 week course of foscarnet, and a rapid neurological improvement was noted. After treatment, PCR for HHV-7 in CSF was negative. Neurological exam was normal one month after treatment initiation.
HHV-7 reactivation may cause neurological disease in patients with HIV infection. Foscarnet is an effective treatment in HHV-7 associated myelitis.
人疱疹病毒7型（HHV-7）再激活偶尔被报道为移植受者脑炎或脊髓炎的病因，但据我们所知，它从未与HIV感染患者的神经系统疾病相关联。我们报告一例HIV感染患者发生急性脊髓炎，脑脊液（CSF）中HHV-7 DNA持续扩增，且对膦甲酸钠治疗反应良好。
一名40岁的HIV感染男性因双腿感觉减退不对称和下肢轻瘫入院。他正在接受依非韦伦、恩曲他滨和替诺福韦治疗，其CD4细胞计数为580/mm³，HIV病毒载量检测不到。磁共振成像显示胸段脊髓在T2和短TI反转恢复（STIR）序列上有局灶性中央高信号，静脉注射钆后有轻微强化。除CSF中HHV-7 DNA扩增外，所有微生物学检查均为阴性。诊断为特发性横贯性脊髓炎，开始用大剂量静脉注射甲泼尼龙治疗。然而，下肢轻瘫持续恶化，首次脑脊液检查12天后获取的第二次脑脊液检查再次显示HHV-7扩增。
该患者接受了为期2周的膦甲酸钠治疗，神经功能迅速改善。治疗后，CSF中HHV-7的聚合酶链反应（PCR）结果为阴性。开始治疗1个月后神经检查正常。
HHV-7再激活可能导致HIV感染患者发生神经系统疾病。膦甲酸钠是治疗HHV-7相关性脊髓炎的有效药物。
