Human pegivirus identified in severe myelitis and optic neuritis in immunocompromised patients: A pathogenic role for a forgotten virus?

Rev Neurol (Paris). 2023 Apr;179(4):361-367. doi: 10.1016/j.neurol.2022.06.011. Epub 2022 Oct 24.

Abstract

The role of Human pegivirus (HPgV) in patients with encephalitis has been recently questioned. We present cases of 4 patients with similar clinical, biological, and radiological characteristics, including a past history of transplantation with long-term immunosuppression and a progressive course of severe and predominantly myelitis, associated in 3 cases with optic neuropathy causing blindness. Extensive workup was negative but analysis of the CSF by use of pan-microorganism DNA- and RNA-based shotgun metagenomics was positive for HPgV. This case series further supports the hypothesis of HPgV CNS infection and highlights the utility of metagenomic next-generation sequencing of CSF in immunocompromised patients.

Keywords: Immunosuppression; Myelitis; Optic neuritis; Pegivirus; Transplant.

MeSH terms

  • Encephalitis*
  • Humans
  • Immunocompromised Host
  • Myelitis* / diagnosis
  • Myelitis* / etiology
  • Optic Neuritis*
  • Pegivirus