Yi Fahang, Qin Ningxiang, Wang Liang
Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Neurol Sci. 2025 Mar;46(3):1323-1327. doi: 10.1007/s10072-024-07860-7. Epub 2024 Nov 5.
Human herpesvirus (HHV)-6 encephalitis secondary to chimeric antigen receptor (CAR)-T cell therapyis relatively rare in clinical practice and needs to be differentiated from immune effector cell-associatedneurotoxicity syndrome (ICANS).
We retrospectively reported a case of HHV-6 encephalitis secondary to CAR-T cell therapy.
A male patient from China with diffuse large B-cell lymphoma underwent chimeric CAR-T cell therapy anddeveloped a generalized rash on the 8 day, followed by cognitive changes, memory loss, and disorientation onthe 14 day after CAR-T cell therapy. Initially, ICANS was suspected. A lumbar puncture was performed on the 18 day. The cerebrospinal fluid (CSF) analysis revealed slightly elevated protein levels and a high presence of HHV-6B sequences by mNGS. Brain MRI showed bilateral hippocampal abnormalities. The patient was ultimatelydiagnosed with HHV-6 encephalitis and treated with ganciclovir and dexamethasone. After one week of treatment,follow-up CSF analysis showed a reduction in HHV-6B sequences. The patient was discharged with improvedmemory and orientation.
HHV-6 encephalitis secondary to CAR-T cell therapy may be easily confused with ICANS. Timely andaggressive diagnostic procedures, such as mNGS of CSF and cranial imaging, along with prompt antiviral therapy,are crucial for improving patient outcomes.
嵌合抗原受体（CAR）-T细胞疗法继发的人类疱疹病毒（HHV）-6脑炎在临床实践中相对罕见，需要与免疫效应细胞相关神经毒性综合征（ICANS）相鉴别。
我们回顾性报告了1例CAR-T细胞疗法继发HHV-6脑炎的病例。
1例来自中国的弥漫性大B细胞淋巴瘤男性患者接受了嵌合CAR-T细胞疗法，在治疗后第8天出现全身性皮疹，随后在第14天出现认知改变、记忆力减退和定向障碍。最初怀疑为ICANS。在第18天进行了腰椎穿刺。脑脊液（CSF）分析显示蛋白水平略有升高，通过宏基因组测序（mNGS）检测到高浓度的HHV-6B序列。脑部磁共振成像（MRI）显示双侧海马异常。该患者最终被诊断为HHV-6脑炎，并接受了更昔洛韦和地塞米松治疗。治疗1周后，随访CSF分析显示HHV-6B序列减少。患者出院时记忆力和定向力有所改善。
CAR-T细胞疗法继发的HHV-6脑炎可能容易与ICANS混淆。及时且积极的诊断程序，如CSF的mNGS和头颅成像，以及及时的抗病毒治疗，对于改善患者预后至关重要。
