This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
To the Editor:
Seeley and colleagues present a case control series of nine patients with post-transplant acute limbic encephalitis (PALE) due to presumed reactivation of the human herpes 6 virus (HHV6).1 We present a case of HHV6 encephalitis that clinically presented as a nonspecific encephalopathy that without appropriate CSF assay would have been overlooked and misdiagnosed.
A 55-year-old woman with refractory diffuse large cell non-Hodgkin lymphoma was treated with high-dose chemotherapy and an unmatched allogenic stem cell transplantation. At week 2, she developed post-transplant graft-versus-host disease (bowel and lungs) managed with oral steroids, tacrolimus, and cyclosporine. Three weeks post-transplant, she developed a slowly progressive confusional state.
Routine laboratory evaluation was unremarkable except for neutropenia (530 cells/uL) and thrombocytopenia (38,000 cells/uL). CT and MR imaging of the brain were normal on two occasions over the course of 10 days. EEG revealed mild diffuse generalized slowing in the 6- to 7-Hz range without epileptiform abnormalities. CSF analysis revealed a white blood cell count of 10 cells/mm3 (all lymphocytes), 1 red blood cell/mm3, glucose 87 mg/dL, and protein 80 mg/dL. Viral, bacterial, and fungal cultures were negative. However, HHV6 was positive by quantitative PCR assay in both blood and CSF. The patient was treated with intravenous ganciclovir and foscarnet and made a complete recovery at discharge.
HHV6 exhibits neurotropism and is a rare cause of encephalitis predominantly seen in immunocompromised and occasionally immunocompetent patients.1–5 Features of a limbic encephalitis with characteristic MRI have been reported …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Hastening the Diagnosis of Amyotrophic Lateral Sclerosis
Dr. Brian Callaghan and Dr. Kellen Quigg