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骨髓移植后出现罕见磁共振成像表现的人类疱疹病毒6型脑炎

Human Herpes Virus 6 Encephalitis Following Bone Marrow Transplantation with Uncommon Magnetic Resonance Imaging Findings.

作者信息

Hwang Jihye, Kim Ji Eun, Roh Jee Hoon, Lee Jae-Hong

机构信息

Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

出版信息

Dement Neurocogn Disord. 2016 Sep;15(3):88-91. doi: 10.12779/dnd.2016.15.3.88. Epub 2016 Sep 30.

DOI:10.12779/dnd.2016.15.3.88
PMID:30906348
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6427967/
Abstract

BACKGROUND

Human Herpes Virus 6 (HHV6) is commonly associated with encephalitis following bone marrow transplantation. However, hippocampal atrophy and global hypometabolism are rare findings in HHV6 encephalitis.

CASE REPORT

A 41-year-old right-handed woman with acute lymphoblastic leukemia presented with fever and mental changes 2 weeks after receiving a sibling bone marrow transplant. The patient's cerebrospinal fluid (CSF) was positive for HHV-6 deoxyribonucleic acid (DNA), but was negative for other viral DNA. Brain magnetic resonance imaging revealed atrophic changes in bilateral medial temporal lobes. Following 4 weeks of ganciclovir therapy, a CSF exam was negative for HHV-6 DNA and the patient's neurological symptoms partially improved. However, she was disoriented and had severe retrograde and anterograde amnesia. 18F-fluorodeoxyglucose-positron emission tomography indicated global hypometabolism in the medial temporal lobes and the fronto-parietal cortices.

CONCLUSIONS

This is a rare and unusual case of hippocampal atrophy in the acute stage of HHV6 encephalitis. Our imaging findings may reflect the chronic indolent course of HHV6 encephalitis.

摘要

背景

人类疱疹病毒6型（HHV6）通常与骨髓移植后的脑炎相关。然而，海马萎缩和全脑代谢减低在HHV6脑炎中是罕见的表现。

病例报告

一名41岁右利手女性，患有急性淋巴细胞白血病，在接受同胞骨髓移植2周后出现发热和精神改变。患者脑脊液（CSF）中HHV-6脱氧核糖核酸（DNA）检测呈阳性，但其他病毒DNA检测为阴性。脑磁共振成像显示双侧内侧颞叶萎缩性改变。更昔洛韦治疗4周后，脑脊液检查HHV-6 DNA呈阴性，患者的神经症状部分改善。然而，她仍存在定向障碍，并有严重的逆行性和顺行性遗忘。18F-氟脱氧葡萄糖正电子发射断层扫描显示内侧颞叶和额顶叶皮质全脑代谢减低。

结论

这是一例HHV6脑炎急性期罕见的海马萎缩病例。我们的影像学表现可能反映了HHV6脑炎的慢性隐匿病程。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d892/6427967/78b6e0489f26/dnd-15-88-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d892/6427967/595af3d086f1/dnd-15-88-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d892/6427967/78b6e0489f26/dnd-15-88-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d892/6427967/595af3d086f1/dnd-15-88-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d892/6427967/78b6e0489f26/dnd-15-88-g002.jpg

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Role of HHV-6B Infection in Mesial Temporal Lobe Epilepsy.人疱疹病毒6B型感染在颞叶内侧癫痫中的作用
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Clin Nucl Med. 2012 Jul;37(7):716-7. doi: 10.1097/RLU.0b013e31824c5e2f.
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Post-transplant acute limbic encephalitis: clinical features and relationship to HHV6.移植后急性边缘叶脑炎：临床特征及其与HHV6的关系
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