Title : Reactivation of human herpesvirus 6 in an immunocompetent patient with encephalitis: A case report
Abstract:
Human herpesvirus 6 (HHV-6) is a common virus usually associated with roseola in children. However, reactivation in immunocompetent adults is particularly rare. This, however, can cause diagnostic challenges, which delays the identification and treatment. When HHV-6 reactivates in adults, it can lead to severe neurological conditions, such as encephalitis and viral meningitis. This case report describes a patient who was a previously healthy 54-year-old immunocompetent female. She presented to the emergency department with altered mental status, fever, and back pain. Initially, blood tests and imaging did not provide a diagnosis. We later performed a lumbar puncture due to concerns of a nervous system infection. Cerebrospinal fluid analysis revealed viral meningitis, and polymerase chain reaction testing confirmed HHV- 6. The patient was initially treated with broad spectrum antibiotics and antiviral therapy, however following infectious disease consultation, the antibiotics and antiviral therapy was discontinued, and supportive care was initiated. The patient's symptoms significantly improved; however, she started experiencing postsequel symptoms, including a post dural headache, vestibular neuritis, neck pain, and dizziness. Further evaluation showed a cerebrospinal fluid leak as a complication of the lumbar puncture. This was treated with an epidural blood patch, which successfully resolved her symptoms. This case emphasizes the importance of considering HHV-6 when faced with unexplained nervous system infections in immunocompetent adults. Additionally, post-sequel symptoms, such as cerebrospinal fluid leaks following lumbar punctures, should be carefully monitored and appropriately treated. Early diagnosis and treatment of HHV-6 is crucial for favorable patient outcomes.
