Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan.
Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan; Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Japan.
J Infect Chemother. 2020 Feb;26(2):265-268. doi: 10.1016/j.jiac.2019.07.016. Epub 2019 Aug 14.
Posterior reversible encephalopathy syndrome (PRES) and human herpesvirus (HHV)-6 encephalitis are both serious neurological complications post hematopoietic stem cell transplantation. Although infection is one of the important causes of PRES, only few cases have reported the relation between PRES and viral infection. Herein, we report the first adult case of PRES concurrent with HHV-6 encephalitis after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. This case suggests that HHV-6 reactivation is associated with the pathogenesis of PRES. Also, PRES and HHV-6 encephalitis cause similar symptoms, and switching the immunosuppressant from calcineurin inhibitor to prednisolone for treating PRES may worsen HHV-6 encephalitis. Therefore, we should pay attention to the complication of HHV-6 encephalitis even after PRES is diagnosed.
后部可逆性脑病综合征(PRES)和人类疱疹病毒(HHV)-6 脑炎都是造血干细胞移植后的严重神经系统并发症。虽然感染是 PRES 的重要原因之一,但仅有少数病例报道了 PRES 与病毒感染之间的关系。本文报告了首例成人急性髓系白血病异基因造血干细胞移植后 PRES 并发 HHV-6 脑炎。该病例提示 HHV-6 再激活与 PRES 的发病机制有关。此外,PRES 和 HHV-6 脑炎引起的症状相似,将免疫抑制剂从钙调磷酸酶抑制剂转换为泼尼松龙治疗 PRES 可能会使 HHV-6 脑炎恶化。因此,即使在诊断出 PRES 后,我们也应该注意 HHV-6 脑炎的并发症。