Bosi A, Zazzi M, Amantini A, Cellerini M, Vannucchi A M, De Milito A, Guidi S, Saccardi R, Lombardini L, Laszlo D, Rossi Ferrini P
Department of Hematology, University of Florence, Italy.
Bone Marrow Transplant. 1998 Aug;22(3):285-8. doi: 10.1038/sj.bmt.1701326.
A complex pattern of neurological dysfunctions with generalized seizures and visual allucinations, but without focal signs, suddenly arose 20 days after an unrelated bone marrow transplant for chronic myelogenous leukemia (CML) in a 13-year-old girl, accompanied by signs of acute skin graft-versus-host disease (GVHD). Magnetic resonance imaging (MRI) revealed multiple bilateral foci of signal abnormalities, which were exclusively localized in the grey matter, sparing the white. Extensive microbiological and virological assays of cerebrospinal fluid (CSF) allowed the identification of HHV-6, variant A, DNA. Further progression of both neurological alterations and of skin and gut GVHD led to a fatal outcome 2 weeks later. A retrospective analysis of both the recipient and donor mononuclear cell suspensions supported the hypothesis that HHV-6 had been acquired from the donor with the bone marrow graft. This report suggests a pathogenetic role of HHV-6 in viral encephalitis in immunocompromised bone marrow transplant (BMT) recipients, and its possible association with GVHD.
一名13岁女孩因慢性粒细胞白血病（CML）接受无关供者骨髓移植20天后，突然出现伴有全身性癫痫发作和视幻觉但无局灶性体征的复杂神经功能障碍模式，同时伴有急性皮肤移植物抗宿主病（GVHD）体征。磁共振成像（MRI）显示双侧多个信号异常灶，这些病灶仅局限于灰质，白质未受累。对脑脊液（CSF）进行的广泛微生物学和病毒学检测发现了人疱疹病毒6型（HHV-6）A变体的DNA。神经功能改变以及皮肤和肠道GVHD的进一步进展在2周后导致了致命结局。对受者和供者单核细胞悬液的回顾性分析支持了HHV-6是通过骨髓移植从供者获得的这一假说。本报告提示HHV-6在免疫受损的骨髓移植（BMT）受者的病毒性脑炎中具有致病作用，及其与GVHD的可能关联。
