Recurrent episodes of hypothermia as a sequela of human herpesvirus 6 encephalitis following cord blood transplantation for acute myeloid leukemia

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  • 臍帯血移植後に併発したHHV-6脳炎の後遺症として低体温発作を繰り返した急性骨髄性白血病
  • 症例報告 第11回日本血液学会関東甲信越地方会 奨励賞 臍帯血移植後に併発したHHV-6脳炎の後遺症として低体温発作を繰り返した急性骨髄性白血病
  • ショウレイ ホウコク ダイ11カイ ニホン ケツエキ ガッカイ カントウ コウシンエツチホウカイ ショウレイショウ サイタイケツ イショク ゴ ニ ヘイハツ シタ HHV-6 ノウエン ノ コウイショウ ト シテ テイタイオン ホッサ オ クリカエシタ キュウセイ コツズイセイ ハッケツビョウ

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Abstract

<p>A 46-year-old female patient underwent a cord blood transplantation (conditioning regimen: fludarabine/busulfan4/melphalan80; graft-versus-host disease (GVHD) prophylaxis: tacrolimus + mycophenolate mofetil) for acute myeloid leukemia (AML) with her 1st hematological complete response to induction therapy (idarubicin 3 days+cytarabine 7 days). She lost her consciousness due to human herpesvirus 6 (HHV-6) encephalitis on day 31, and therefore, we increased the foscarnet dosage (from 120 mg/kg to 180 mg/kg). Her consciousness level improved after treatment. However, 8 hours of sudden hypothermia occurred with hyperhidrosis, hypertension, and subsequent hyperglycemia on day 34. Her condition did not improve even after administration of anticonvulsant, steroid pulse, or intravenous immunoglobulin. A total of 75 attacks were observed until she was discharged on day 471. She has not shown chronic GVHD or relapsed AML since then. However, HHV-6 caused prolonged damage to her hypothalamus as observed through magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) using 99mTc ethyl cysteinate dimer even when the virus was not detected from her cerebrospinal fluid. This damage can be responsible for the hypothermia attacks. This is the first case report of prolonged series of hypothermia attacks for over a year as a sequela of HHV-6 encephalitis after a cord blood transplantation for AML.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 61 (3), 274-279, 2020

    The Japanese Society of Hematology

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