valganciclovir and Encephalitis--Viral

Human herpesvirus (HHV)-6 reactivation is associated with severe forms of encephalitis among patients undergoing hematopoietic stem cell transplantation. Cases in non-neutropenic patients are uncommon. The efficacy of ganciclovir and other compounds that are used for the treatment of HHV-6 encephalitis remains suboptimal and linked to toxicity. Valganciclovir, the oral prodrug of ganciclovir, could be practical to treat outpatients, but it is not commonly used for severe cases. We report a case of HHV-6 encephalitis in a non-neutropenic patient successfully treated with valganciclovir and undergoing therapeutic drug monitoring in plasma and in the cerebrospinal fluid. Resolution of infectious foci was documented by cerebral MRI and F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). A review of the literature on HHV-6 encephalitis is also reported.

Topics: Antiviral Agents; DNA, Viral; Drug Administration Schedule; Drug Monitoring; Encephalitis, Viral; Fluorodeoxyglucose F18; Ganciclovir; Herpesvirus 6, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Roseolovirus Infections; Treatment Outcome; Valganciclovir

Topics: Adult; Antiviral Agents; Blood; Brain; CD4 Lymphocyte Count; Encephalitis, Viral; Ganciclovir; Herpesvirus 6, Human; HIV Infections; HIV-1; Humans; Magnetic Resonance Imaging; Male; Radiography; Roseolovirus Infections; Treatment Outcome; Valganciclovir; Viral Load

We describe successful treatment of 3 cases of human herpesvirus 6 (HHV-6) encephalitis/myelitis following cord blood transplantation (CBT). Ganciclovir (GCV) (10 mg/kg/day) reduced HHV-6 load to undetectable levels in cerebrospinal fluid (CSF). Early dose reduction in the presence of HHV-6 detectable in CSF resulted in an increased HHV-6 load. GCV was capably shifted to valganciclovir (VGCV) with an almost equivalent concentration. GCV/VGCV may be effective for HHV-6 encephalitis/myelitis after CBT, although HHV-6 load in CSF should be monitored.

Topics: Adult; Antiviral Agents; Child, Preschool; DNA, Viral; Encephalitis, Viral; Female; Fetal Blood; Ganciclovir; Hematopoietic Stem Cell Transplantation; Herpesvirus 6, Human; Humans; Male; Myelitis; Myeloablative Agonists; Roseolovirus Infections; Transplantation Conditioning; Treatment Outcome; Valganciclovir; Viral Load; Young Adult

Epstein-Barr virus (EBV) is a common infection which usually produces mild or no symptoms in immunocompetent individuals. In human immunodeficiency virus (HIV) associated immunosuppression it is most commonly associated with malignancy which usually occurs at very low CD4+ cell counts. We describe a newly diagnosed HIV-positive patient who presented with headaches and cerebellar signs. She was incorrectly diagnosed with cerebral tuberculosis (TB) infection based on the histology report from a cerebellar biopsy specimen. After extensive investigation including cerebrospinal fluid sampling and reanalysis of the brain biopsy specimens she was found to have EBV-associated cerebral vasculitis and encephalitis and was successfully treated with valganciclovir and steroids. Whilst there are a few reports of EBV-associated encephalitis, cerebral vasculitis secondary to EBV in the context of HIV infection has not previously been described in the literature.

Topics: Adult; Anti-Inflammatory Agents; Antiviral Agents; Encephalitis, Viral; Epstein-Barr Virus Infections; Female; Ganciclovir; HIV Infections; Humans; Steroids; Treatment Outcome; Valganciclovir; Vasculitis, Central Nervous System