Abstract
Human herpes virus-6 (HHV-6) reactivation is a well-recognised complication following haematological stem cell transplantation, but it is novel in the context of combination immunomodulatory therapy for autoimmune disease. We report a case of severe anterograde amnesia caused by HHV-6 encephalitis in a young female patient on rituximab, azathioprine and prednisolone for dermatomyositis (DM). The use of targeted biologic treatments for systemic autoimmune connective tissue diseases (CTDs) is increasing, particularly when refractory to conventional management. The anti-CD20 B cell depleting monoclonal antibody, rituximab is now increasingly used, often in combination with conventional immunomodulatory treatments, in certain autoimmune neurological conditions and systemic CTDs including DM. Physicians should be aware of the possibility of HHV-6 in those who develop encephalitis while CD20 B cell deplete, especially in the presence of additional immunomodulatory therapies. Prompt diagnosis and treatment of HHV-6 encephalitis with evidence-based anti-viral therapy may help reduce the extent of irreversible morbidity such as amnesia.
Keywords:
Amnesia; Dermatomyositis; Encephalitis; HHV-6; Rituximab.
MeSH terms
-
Acyclovir / therapeutic use
-
Adult
-
Amnesia, Anterograde / drug therapy
-
Amnesia, Anterograde / etiology
-
Amnesia, Anterograde / immunology
-
Amnesia, Anterograde / virology*
-
Antiviral Agents / therapeutic use*
-
Azathioprine / adverse effects
-
B-Lymphocytes / drug effects
-
B-Lymphocytes / immunology
-
B-Lymphocytes / pathology
-
Dermatomyositis / drug therapy
-
Dermatomyositis / immunology
-
Dermatomyositis / pathology*
-
Encephalitis, Viral / complications
-
Encephalitis, Viral / drug therapy
-
Encephalitis, Viral / immunology
-
Encephalitis, Viral / virology*
-
Female
-
Herpesvirus 6, Human / genetics*
-
Herpesvirus 6, Human / isolation & purification
-
Humans
-
Immunologic Factors / adverse effects
-
Lymphocyte Depletion
-
Penicillanic Acid / analogs & derivatives
-
Penicillanic Acid / therapeutic use
-
Piperacillin / therapeutic use
-
Piperacillin, Tazobactam Drug Combination
-
Prednisolone / adverse effects
-
Rituximab / adverse effects
-
Roseolovirus Infections / complications
-
Roseolovirus Infections / drug therapy
-
Roseolovirus Infections / immunology
-
Roseolovirus Infections / virology*
Substances
-
Antiviral Agents
-
Immunologic Factors
-
Piperacillin, Tazobactam Drug Combination
-
Rituximab
-
Penicillanic Acid
-
Prednisolone
-
Azathioprine
-
Piperacillin
-
Acyclovir