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Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab

Primary infection with human herpesvirus-6 (HHV-6) commonly occurs at an early age in children, most often at 3 years of age, and is associated with childhood diseases, such as exanthema subitum, hepatitis, febrile convulsions, or encephalitis. However, the virus occasionally reactivates from its la...

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Autores principales: Kuwahara-Ota, Saeko, Chinen, Yoshiaki, Mizuno, Yoshimi, Takimoto-Shimomura, Tomoko, Matsumura-Kimoto, Yayoi, Tanba, Kazuna, Tsukamoto, Taku, Mizutani, Shinsuke, Shimura, Yuji, Kobayashi, Tsutomu, Horiike, Shigeo, Kuroda, Junya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957066/
https://www.ncbi.nlm.nih.gov/pubmed/29785130
http://dx.doi.org/10.2147/IDR.S163686
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author Kuwahara-Ota, Saeko
Chinen, Yoshiaki
Mizuno, Yoshimi
Takimoto-Shimomura, Tomoko
Matsumura-Kimoto, Yayoi
Tanba, Kazuna
Tsukamoto, Taku
Mizutani, Shinsuke
Shimura, Yuji
Kobayashi, Tsutomu
Horiike, Shigeo
Kuroda, Junya
author_facet Kuwahara-Ota, Saeko
Chinen, Yoshiaki
Mizuno, Yoshimi
Takimoto-Shimomura, Tomoko
Matsumura-Kimoto, Yayoi
Tanba, Kazuna
Tsukamoto, Taku
Mizutani, Shinsuke
Shimura, Yuji
Kobayashi, Tsutomu
Horiike, Shigeo
Kuroda, Junya
author_sort Kuwahara-Ota, Saeko
collection PubMed
description Primary infection with human herpesvirus-6 (HHV-6) commonly occurs at an early age in children, most often at 3 years of age, and is associated with childhood diseases, such as exanthema subitum, hepatitis, febrile convulsions, or encephalitis. However, the virus occasionally reactivates from its latent state in immunosuppressed adults, especially post-transplant, resulting in serious disseminated, sometimes life-threatening end-organ complications. Herein, we report a case of a 68-year-old man with relapsed follicular lymphoma who developed HHV-6 pneumonitis. Eighteen months after achieving second complete remission by salvage immunochemotherapy with rituximab, the patient was complicated by pneumonia, with chest computed tomography finding showing disseminated nodular shadows with ground-glass opacity in both lungs. While empiric antibiotic and antifungal therapies did not improve the pneumonia, polymerase chain reaction–based viral screening tests on his bronchoalveolar lavage fluid detected the presence of HHV-6 DNA, and ganciclovir treatment quickly resolved the pneumonia, indicating that he suffered from HHV-6 pneumonitis. He had no other HHV-6–related end-organ damage, such as encephalitis. This case suggests that, although extremely rare, HHV-6 reactivation should be considered as one of the candidate pathogens for pulmonary complications of uncertain etiology in patients who have been treated with intensive immunosuppressive chemotherapy, even without hematopoietic stem cell transplantation. Furthermore, polymerase chain reaction–based viral screening testing on bronchoalveolar lavage fluid is a powerful diagnostic tool for pneumonitis due to viral reactivation, including HHV-6 reactivation.
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spelling pubmed-59570662018-05-21 Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab Kuwahara-Ota, Saeko Chinen, Yoshiaki Mizuno, Yoshimi Takimoto-Shimomura, Tomoko Matsumura-Kimoto, Yayoi Tanba, Kazuna Tsukamoto, Taku Mizutani, Shinsuke Shimura, Yuji Kobayashi, Tsutomu Horiike, Shigeo Kuroda, Junya Infect Drug Resist Case Report Primary infection with human herpesvirus-6 (HHV-6) commonly occurs at an early age in children, most often at 3 years of age, and is associated with childhood diseases, such as exanthema subitum, hepatitis, febrile convulsions, or encephalitis. However, the virus occasionally reactivates from its latent state in immunosuppressed adults, especially post-transplant, resulting in serious disseminated, sometimes life-threatening end-organ complications. Herein, we report a case of a 68-year-old man with relapsed follicular lymphoma who developed HHV-6 pneumonitis. Eighteen months after achieving second complete remission by salvage immunochemotherapy with rituximab, the patient was complicated by pneumonia, with chest computed tomography finding showing disseminated nodular shadows with ground-glass opacity in both lungs. While empiric antibiotic and antifungal therapies did not improve the pneumonia, polymerase chain reaction–based viral screening tests on his bronchoalveolar lavage fluid detected the presence of HHV-6 DNA, and ganciclovir treatment quickly resolved the pneumonia, indicating that he suffered from HHV-6 pneumonitis. He had no other HHV-6–related end-organ damage, such as encephalitis. This case suggests that, although extremely rare, HHV-6 reactivation should be considered as one of the candidate pathogens for pulmonary complications of uncertain etiology in patients who have been treated with intensive immunosuppressive chemotherapy, even without hematopoietic stem cell transplantation. Furthermore, polymerase chain reaction–based viral screening testing on bronchoalveolar lavage fluid is a powerful diagnostic tool for pneumonitis due to viral reactivation, including HHV-6 reactivation. Dove Medical Press 2018-05-14 /pmc/articles/PMC5957066/ /pubmed/29785130 http://dx.doi.org/10.2147/IDR.S163686 Text en © 2018 Kuwahara-Ota et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Case Report
Kuwahara-Ota, Saeko
Chinen, Yoshiaki
Mizuno, Yoshimi
Takimoto-Shimomura, Tomoko
Matsumura-Kimoto, Yayoi
Tanba, Kazuna
Tsukamoto, Taku
Mizutani, Shinsuke
Shimura, Yuji
Kobayashi, Tsutomu
Horiike, Shigeo
Kuroda, Junya
Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab
title Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab
title_full Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab
title_fullStr Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab
title_full_unstemmed Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab
title_short Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab
title_sort human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957066/
https://www.ncbi.nlm.nih.gov/pubmed/29785130
http://dx.doi.org/10.2147/IDR.S163686
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