Gómez-Gómez VA, García-Arce SB, Lucas-Alvarado H, León-Vallejo S, Reyes-Ortega D, Torres-Pérez LH, Pérez-Villa M, Santana-Marbán SE

Language: Spanish
References: 14
Page: 203-206
PDF size: 204.79 Kb.

ABSTRACT

We present the case of a 21-year-old male patient diagnosed with CDC 3/WHO 4 stage HIV, with poor adherence to antiretroviral therapy and ongoing miliary tuberculosis. He was admitted with progressive holocranial headache and deteriorating alertness. A clinical, imaging, and microbiological approach was performed, including a lumbar puncture and a FilmArray^® multiplex molecular panel in cerebrospinal fluid (CSF).
Results. HHV-6 was identified in CSF by multiplex polymerase chain reaction (PCR). The patient presented a torpid evolution with refractory status epilepticus, requiring sedation, intubation, and placement of a ventriculoperitoneal shunt valve. Despite antiviral treatment with valganciclovir, he developed septic shock and brain death confirmed by imaging tests and an electroencephalogram. It was not possible to obtain a specific viral load for HHV-6. Conclusions. HHV-6 meningoencephalitis should be considered in the differential diagnosis of encephalopathy in patients with advanced HIV disease. Coinfection with miliary tuberculosis can worsen the clinical course. Timely diagnosis and antiviral therapy are key to improving the prognosis.

REFERENCES

1. Jiménez Bolaños, R., Díaz Díaz, A., Sánchez-MirandaRomán, I. y Castellano Santana, J.P., “Meningoencefalitispor hhv-6 en un paciente inmunocompetente asociadoa coinfección por virus de la gripe”, Neurología, 2021, 36 (4): 329-330.

2. Ward, K.N., “Human herpesvirus 6 and 7 infections”,Curr Op Infect Dis, 2005, 18: 247-252.

3. Deeks, S.G., Overbaugh, J., Phillips, A. y Buchbinder, S.,“hiv infection”, Nat Rev Dis Primers, 2015, 1: 15035.

4. Munawwar, A. y Singh, S., “Human herpesviruses as copathogensof hiv infection, their role in hiv transmission,and disease progression”, J Lab Physicians, 2016, 8 (1): 5-18.

5. Ongrádi, J., Ablashi, D.V., Yoshikawa, T., Stercz, B. yOgata, M., “Roseolovirus-associated encephalitis inimmunocompetent and immunocompromised individuals”,J Neurovirol, 2017, 23 (1): 1-19.

6. Da Cunha, G.H., Rodriguez de Oliveira Lima, R.C., DeOliveira Lopes, M.V., Gimeniz Galvão, M.T., RodriguesSiqueira L. y Soares Monteiro Fontenele, M., “Mortality,survival and prognostic factors of people with aidsin intensive care unit”, Rev Esc Enferm usp, 2021, 55:e20210121.

7. Trickey, A., McGinnis, K., Gill, M.J., Abgrall, S., Berenguer,J., Wyen, C. et al., “Longitudinal trends in causesof death among adults with hiv on antiretroviral therapyin Europe and North America from 1996 to 2020: acollaboration of cohort studies”, Lancet hiv, 2024,11 (3):e176-e185.

8. Komaroff, A.L., Pellett, P.E. y Jacobson, S., “Humanherpesviruses 6A and 6B in brain diseases: associationversus causation”, Clin Microbiol Rev, 2020, 34 (1):e00143-20.

9. Yilmaz, M., Yasar, C., Aydin, S., Derin, O., Polat, B., Ertan,G. et al., “Human herpesvirus 6 encephalitis in animmunocompetent pregnant patient and review of theliterature”, Clin Neurol Neurosurg, 2018, 171: 106-108.

10. Brnbaum, T., Padovan, C.S., Sporer, B., Rupprecht, T.A.,Ausserer, H. et al., “Severe meningoencephalitis causedby human herpesvirus 6 type b in an immunocompetentwoman treated with ganciclovir”, Clin Infect Dis, 2005,40 (6): 887-889.

11. Noguchi, T., Yoshiura, T., Hiwatashi, A., Togao, O.,Yamashita, K., Nagao, E. et al., “ct and mri findings ofhuman herpesvirus 6-associated encephalopathy: comparisonwith findings of herpes simplex virus encephalitis”,ajr Am J Roentgenol, 2010, 194 (3): 754-760.

12. Provenzale, J.M., Van Landingham, K. y White, L.E.,“Clinical and imaging findings suggesting human herpesvirus6 encephalitis”, Pediatr Neurol, 2010, 42 (1):32-39.

13. Ward, K.N., Leong, H.N., Thiruchelvam, A.D., Atkinson,C.E. y Clark, D.A., “Human herpesvirus 6 dna levels incerebrospinal fluid due to primary infection differ fromthose due to chromosomal viral integration and haveimplications for diagnosis of encephalitis”, J Clin Microbiol,2007, 45 (4): 1298-1304.

14. Cailleaux, M., Pilmis, B., Mizrahi, A., Lourtet-Hascoet, J.,Nguyen Van, J.C., Alix, L. et al., “Impact of a multiplexpcr assay (FilmArray®) on the management of patientswith suspected central nervous system infections”, EurJ Clin Microbiol Infect Dis, 2020, 39 (2): 293-297.