High-dose ganciclovir in HHV-6 encephalitis of an immunocompetent child

Pediatr Neurol. 2010 Jul;43(1):53-6. doi: 10.1016/j.pediatrneurol.2010.02.003.

Abstract

Encephalitis and other neurologic complications, including acute necrotizing encephalopathy, are associated with human herpesvirus-6 infection. Antiviral treatment against human herpesvirus-6 infection is indicated only for immunocompromised patients. We describe a 15-month-old immunocompetent child with severe human herpesvirus-6-induced encephalitis. The primary infection was characterized by human herpesvirus-6 DNA in cerebrospinal fluid and serum, the presence of serum human herpesvirus-6 immunoglobulin M antibodies, and a rise in serum human herpesvirus-6 immunoglobulin G antibodies. Magnetic resonance imaging demonstrated multiple, partly symmetric, necrotic lesions in the pons, medulla oblongata, thalamus, external capsules, and occipital subcortical and cortical areas. High-dose ganciclovir (18 mg/kg/day) was used as antiviral treatment, without side effects. A pharmacokinetic analysis of ganciclovir was performed. The initial recovery from severe disease was good. At 3-year follow-up, neurologic sequelae included epilepsy and ataxia. This case suggests that treatment with ganciclovir should be considered in human herpesvirus-6 central nervous system infections because the neurologic sequelae may otherwise be severe. Controlled, prospective, clinical trials are warranted, to analyze the pharmacokinetics of ganciclovir in infants.

Publication types

  • Case Reports

MeSH terms

  • Antiviral Agents / administration & dosage
  • Antiviral Agents / therapeutic use
  • Encephalitis, Viral / cerebrospinal fluid
  • Encephalitis, Viral / drug therapy*
  • Female
  • Ganciclovir / administration & dosage*
  • Ganciclovir / therapeutic use
  • Herpesvirus 6, Human*
  • Humans
  • Infant
  • Roseolovirus Infections / cerebrospinal fluid
  • Roseolovirus Infections / drug therapy*
  • Treatment Outcome

Substances

  • Antiviral Agents
  • Ganciclovir