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Hyponatremia associated with human herpesvirus-6 (HHV-6) encephalitis after allogeneic hematopoietic stem cell transplantation: A presentation different from HHV-6 myelitis

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Abstract

Human herpesvirus-6 (HHV-6) encephalitis and myelitis following allogeneic hematopoietic stem cell transplantation (HSCT) is frequently life-threatening. We retrospectively evaluated the clinical significance of hyponatremia in cases of HHV-6 encephalitis/myelitis. Using an institutional database and medical records, we identified and retrospectively analyzed 16 cases of HHV-6 encephalitis and/or myelitis after allogeneic HSCT. HHV-6 encephalitis and myelitis were defined as the symptoms/signs with HHV-6-DNA in the cerebrospinal fluid. Seizure and memory disorder were defined as symptoms/signs of encephalitis, and dysesthesia and vesicorectal disorder as those of myelitis. Five patients developed encephalitis with or without myelitis, and 11 patients developed myelitis alone. Hyponatremia (median 129.1 mEq/L; range 125.9–130.1) was observed in all five patients with HHV-6 encephalitis at diagnosis, and values were significantly lower than those in patients with HHV-6 myelitis alone (median 137.6; range 134.0–142.2; P < 0.01). In three of the five patients with encephalitis, the decrease in sodium level preceded the clinical onset of encephalitis by one or two days. These results suggest that hyponatremia may be an important manifestation of HHV-6 encephalitis, but not of myelitis, and could be a useful tool for the early prediction or diagnosis of HHV-6 encephalitis.

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References

  1. Ogata M, Fukuda T, Teshima T. Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: what we do and do not know. Bone Marrow Transplant. 2015;50:1030–6.

    Article  CAS  PubMed  Google Scholar 

  2. Mori T, Mihara A, Yamazaki R, Shimizu T, Aisa Y, Suzuki S, et al. Myelitis associated with human herpes virus 6 (HHV-6) after allogeneic cord blood transplantation. Scand J Infect Dis. 2007;39:276–8.

    Article  PubMed  Google Scholar 

  3. Sakai R, Kanamori H, Motohashi K, Yamamoto W, Matsuura S, Fujita A, et al. Long-term outcome of human herpesvirus-6 encephalitis after allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2011;17:1389–94.

    Article  PubMed  Google Scholar 

  4. Ogata M, Satou T, Inoue Y, Takano K, Ikebe T, Ando T, et al. Foscarnet against human herpesvirus (HHV)-6 reactivation after allo-SCT: breakthrough HHV-6 encephalitis following antiviral prophylaxis. Bone Marrow Transplant. 2013;48:257–64.

    Article  CAS  PubMed  Google Scholar 

  5. Kawaguchi T, Takeuchi M, Kawajiri C, Abe D, Nagao Y, Yamazaki A, et al. Severe hyponatremia caused by syndrome of inappropriate secretion of antidiuretic hormone developed as initial manifestation of human herpesvirus-6-associated acute limbic encephalitis after unrelated bone marrow transplantation. Transpl Infect Dis. 2013;15:E54–7.

    Article  CAS  PubMed  Google Scholar 

  6. Toriumi N, Kobayashi R, Yoshida M, Iguchi A, Sarashina T, Okubo H, et al. Risk factors for human herpesvirus 6 reactivation and its relationship with syndrome of inappropriate antidiuretic hormone secretion after stem cell transplantation in pediatric patients. J Pediatr Hematol Oncol. 2014;36:379–83.

    Article  CAS  PubMed  Google Scholar 

  7. de Souza Franceschi FL, Green J, Cayci Z, Mariash E, Ezzeddine M, Bachanova V, et al. Human herpesvirus 6 is associated with status epilepticus and hyponatremia after umbilical cord blood transplantation. Can J Infect Dis Med Microbiol. 2014;25:170–2.

    PubMed  PubMed Central  Google Scholar 

  8. Yamane A, Mori T, Suzuki S, Mihara A, Yamazaki R, Aisa Y, et al. Risk factors for develo** human herpesvirus 6 (HHV-6) reactivation after allogeneic hematopoietic stem cell transplantation and its association with central nervous system disorders. Biol Blood Marrow Transplant. 2007;13:100–6.

    Article  CAS  PubMed  Google Scholar 

  9. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  10. Kobayashi R, Iguchi A, Nakajima M, Sato T, Yoshida M, Kaneda M, et al. Hyponatremia and syndrome of inappropriate antidiuretic hormone secretion complicating stem cell transplantation. Bone Marrow Transplant. 2004;34:975–9.

    Article  CAS  PubMed  Google Scholar 

  11. Suzuki Y, Kobayashi R, Iguchi A, Sato T, Kaneda M, Kobayashi K, et al. The syndrome of inappropriate secretion of antidiuretic hormone associated with SCT: clinical differences following SCT using cord blood and BM/peripheral blood. Bone Marrow Transplant. 2008;42:743–8.

    Article  CAS  PubMed  Google Scholar 

  12. Wei J, **ao Y, Yu X, Zhou J, Zhang Y. Early onset of syndrome of inappropriate antidiuretic hormone secretion (SIADH) after allogeneic haematopoietic stem cell transplantation: case report and review of the literature. J Int Med Res. 2010;38:705–10.

    Article  CAS  PubMed  Google Scholar 

  13. Palmer BF. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol Metab. 2003;14:182–7.

    Article  CAS  PubMed  Google Scholar 

  14. Rovit RL, Sigler MH. Hyponatremia with herpes simplex encephalitis. Possible relationship of limbic lesions and ADH secretion. Arch Neurol. 1964;10:595–603.

    Article  CAS  PubMed  Google Scholar 

  15. Vincent A, Buckley C, Schott JM, Baker I, Dewar BK, Detert N, et al. Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain. 2004;127:701–12.

    Article  PubMed  Google Scholar 

  16. Saccardi T, Pedroso JL, Bernardino T, Barsottini OG, Ferraz HB. Subacute cognitive impairment, hyponatremia and mesial temporal lobe lesions: a typical presentation of voltage-gated potassium channel (VGKC) antibody-associated limbic encephalitis. Arq Neuropsiquiatr. 2011;69:990–1.

    Article  PubMed  Google Scholar 

  17. Ogata M, Satou T, Kadota J, Saito N, Yoshida T, Okumura H, et al. Human herpesvirus 6 (HHV-6) reactivation and HHV-6 encephalitis after allogeneic hematopoietic cell transplantation: a multicenter, prospective study. Clin Infect Dis. 2013;57:671–8.

    Article  PubMed  Google Scholar 

  18. Kawamura K, Hayakawa J, Akahoshi Y, Harada N, Nakano H, Kameda K, et al. Low-dose acyclovir prophylaxis for the prevention of herpes simplex virus and varicella zoster virus diseases after autologous hematopoietic stem cell transplantation. Int J Hematol. 2015;102:230–7.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors are indebted to Yuri Niizuma and Kaori Yanai for their skillful data management and assistance; and to Satomi Yamanaka for her dedicated care of the patients and their family members.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Koichi Murakami, Sumiko Kohashi, Masatoshi Sakurai, Jun Kato, Takaaki Toyama, Yuya Koda, Yusuke Yamane, Risa Hashida, Ryohei Abe, Rie Yamazaki, Taku Kikuchi, Takayuki Shimizu, Shinichiro Okamoto & Takehiko Mori

  2. Division of Neurology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    Shigeaki Suzuki

  3. Center for Infectious Disease and Infection Control, Keio University Hospital, Tokyo, Japan

    Naoki Hasegawa

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  1. Koichi Murakami
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  2. Sumiko Kohashi
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  3. Masatoshi Sakurai
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  4. Jun Kato
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  9. Ryohei Abe
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  15. Shinichiro Okamoto
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  16. Takehiko Mori
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Correspondence to Takehiko Mori.

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Murakami, K., Kohashi, S., Sakurai, M. et al. Hyponatremia associated with human herpesvirus-6 (HHV-6) encephalitis after allogeneic hematopoietic stem cell transplantation: A presentation different from HHV-6 myelitis. Int J Hematol 106, 436–440 (2017). https://doi.org/10.1007/s12185-017-2254-9

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  • DOI: https://doi.org/10.1007/s12185-017-2254-9

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