SHM Converge Scientific Abstract ePoster Gallery-HHV-6 Encephalitis in an Immunocompetent Child: A Steroid- Responsive Case Complicated by Cerebral Vein Thrombosis

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This case describes an 11-year-old immunocompetent boy who developed progressively worsening bifrontal headaches, photophobia, eye twitching, and episodes of confusion. His symptoms escalated over several weeks and were initially treated as cluster headaches, but persistent neurologic complaints raised concern for seizures. CT of the head was normal, while MRI showed increased FLAIR signal in the left medial temporal lobe. EEG demonstrated left-hemispheric spikes and generalized 3-Hz spike-wave activity, supporting focal epilepsy.<br /><br />He was transferred to the PICU for status epilepticus management. Lumbar puncture showed elevated opening pressure, and both CSF and serum PCR were positive for HHV-6. Despite a broad infectious and autoimmune workup being unrevealing, the team initially started IVIG for suspected post-infectious encephalitis and added phenobarbital for ongoing electrographic seizures. Repeat MRI later revealed cerebral venous sinus thrombosis involving bridging veins and the superior sagittal sinus. High-dose corticosteroids were then initiated, leading to marked clinical improvement.<br /><br />The authors conclude that HHV-6 encephalitis can occur even in immunocompetent children and may present with seizures, temporal lobe abnormalities, and intracranial venous thrombosis. The strong response to corticosteroids suggests a post-viral autoimmune mechanism rather than direct viral injury. This case highlights the importance of considering HHV-6 in pediatric encephalitis and recognizing that severe neurologic complications can occur outside the immunocompromised setting.

Asset Subtitle

Ayesha Khalid

Meta Tag

Author List Ayesha Khalid, Mary Payne Payne, Roheen Khalid, Saubhagyi Singh

Category Clinical Vignettes

Concept HHV-6 Encephalitis

Concept Status Epilepticus

Concept HHV-6 PCR

Concept Immunocompetent Child

Concept Focal Seizure

Distinguished Non-Finalist

Presenter Organization Marshall University Joan C. Edward School of Medicine

Presenting Author Ayesha Khalid

Track Pediatric

Keywords

HHV-6 encephalitis

immunocompetent child

status epilepticus

temporal lobe abnormality

cerebral venous sinus thrombosis

pediatric seizures

electroencephalogram

lumbar puncture

intracranial hypertension

corticosteroid response

HHV-6 Encephalitis

Status Epilepticus

HHV-6 PCR

Immunocompetent Child

Focal Seizure