Analysis of five cases of human herpesvirus-6 myelitis among 121 cord blood transplantations

• Published in: International journal of hematology Vol. 107; no. 3; pp. 363 - 372
• Main Authors: Ueki, Toshimitsu, Hoshi, Kenichi, Hiroshima, Yuki, Sumi, Masahiko, Ichikawa, Naoaki, Ogata, Masao, Satou, Takako, Fukuda, Takahiro, Kobayashi, Hikaru
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.03.2018; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Allografts; Antiviral agents; Antiviral Agents - therapeutic use; Autonomic Nervous System Diseases - etiology; Bladder; Cerebrospinal fluid; Cord blood; Cord Blood Stem Cell Transplantation - adverse effects; Extrapyramidal system; Female; Fever; Fever - etiology; Foscarnet; Foscarnet - therapeutic use; Ganciclovir; Ganciclovir - therapeutic use; Hematology; Herpesvirus 6, Human; Humans; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Myelitis; Myelitis - diagnostic imaging; Myelitis - drug therapy; Myelitis - etiology; Myelitis - virology; Neuralgia; NMR; Nuclear magnetic resonance; Oncology; Original Article; Pain; Pain - etiology; Patients; Pruritus; Pruritus - etiology; Rectum; Spinal cord; Spinal Cord - diagnostic imaging; Therapy; Transplantation; Treatment Outcome; Urinary bladder; Young Adult; Human herpesvirus-6; Myelitis; Pain; Cord blood transplantation; Pre-engraftment immune reaction
• ISSN: 0925-5710; 1865-3774; 1865-3774
• DOI: 10.1007/s12185-017-2347-5

Reports of myelitis associated with human herpesvirus-6 (HHV-6) following allogeneic transplantation are rare. Of 121 cases of cord blood transplantation (CBT) performed at Nagano Red Cross Hospital, five cases (4.1%) of HHV-6 myelitis developed at around the time of engraftment. The major symptom identified in all five patients was superficial pain or pruritus linked to segmental levels of the spinal cord. Other identified symptoms were fever or low-grade fever in all five patients, autonomic nerve disorder in four patients, bladder and rectal disturbance in two patients, and extrapyramidal disorder in two patients. These symptoms were experienced primarily 16–39 days after CBT. HHV-6 PCR tests were all positive for cerebrospinal fluid and for plasma. Of the four cases tested by magnetic resonance imaging (MRI), three showed spinal cord abnormality. Antiviral therapy using foscarnet or ganciclovir was effective in every case. Although one case treated from 12 days after onset experienced long-term pain resembling postherpetic neuralgia, symptoms in the four cases were completely relieved after antiviral therapy. In summary, the major symptoms of HHV-6 myelitis were superficial pain linked to segmental levels of the spinal cord. Prognosis may be improved by early initiation of antiviral therapy.