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Human herpesvirus type 6 (HHV-6) is expressed in the form of two variants, A and B. These subtypes share a high level of sequence homology, but differ in their phenotype.1 HHV-6B is acquired early in life, and causes roseola, whereas HHV-6A is not linked to any clearly defined syndrome, is often acquired later in life, and appears to exhibit specific neurotropic properties.1–3 We report a case of encephalomyelitis associated with acute HHV-6A infection.
Case report.
A 59-year-old, previously healthy woman developed flu-like symptoms with high fever. She then noticed rapidly progressive sensory loss in both legs, followed by urinary incontinence, mild headaches, and speech difficulties. On admission, 4 weeks after symptoms onset, neurologic examination showed a mild dysarthria, a Th7 cutaneous sensory level, and a bilateral paresis of the tibialis anterior. Gait was ataxic and the Romberg test was positive.
MRI demonstrated cerebellar peduncles and spinal cord lesions (figure, A through C). A lumbar puncture performed 4 weeks after symptoms onset (i.e., at admission to our hospital) yielded a normal CSF. Blood tests performed 1 week after symptoms onset showed an increase of total WBC count (11.78 G/L), transaminases levels (AST 139 U/L, ALT 193 U/L), and C-reactive protein (20 mg/L). At admission, all values normalized. HIV, hepatitis (A–D), Lyme disease, and European tick-borne encephalitis were excluded. HHV-6 serologies showed a progressive reduction of initially high HHV-6 IgM titers coupled …
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