Human herpesvirus 6 (HHV-6) associated permanent hyponatremia in umbilical cord blood transplant recipient

Transpl Immunol. 2023 Feb:76:101742. doi: 10.1016/j.trim.2022.101742. Epub 2022 Nov 11.

Abstract

Long-term neurocognitive deficits after human herpesvirus-6 (HHV-6) infection are common in stem-cell transplant recipients, but SIADH (Syndrome of inappropriate antidiuretic hormone secretion) with persistent hyponatremia is rare. A 51-year-old woman presented with somnolence, hyponatremia (121 mmol/L) and HHV-6 viremia (80,330 copies/ml) on day +22 post umbilical cord blood transplant (UCBT). With waterrestriction, tolvaptan and combination of foscarnet and ganciclovir, patient's hyponatremia and HHV-6 viremia improved. On day +94 UCBT, hyponatremia and HHV-6 viremia recurred. Foscarnet was restarted and continued until day +269 UCBT due to multiple HHV-6 recurrences with persistent hyponatremia. At day +712, patient remains on water-restriction, tolvaptan for continuous hyponatremia from SIADH.

Keywords: Human herpesvirus-6; Hyponatremia; Post-transplant acute limbic encephalitis; Umbilical cord blood transplant.

Publication types

  • Case Reports

MeSH terms

  • Cord Blood Stem Cell Transplantation* / adverse effects
  • Female
  • Foscarnet / therapeutic use
  • Herpesvirus 6, Human*
  • Humans
  • Hyponatremia* / etiology
  • Hyponatremia* / therapy
  • Inappropriate ADH Syndrome* / etiology
  • Inappropriate ADH Syndrome* / therapy
  • Middle Aged
  • Roseolovirus Infections* / drug therapy
  • Tolvaptan
  • Transplant Recipients
  • Viremia

Substances

  • Foscarnet
  • Tolvaptan