SHM Converge Scientific Abstract ePoster Gallery-Under Pressure: HHV-6 Encephalitis Causing Increased Intracranial Pressure

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This case describes a 9-year-old boy with X-linked lymphoproliferative syndrome who developed fever, rash, nausea, positional headache, and lethargy three weeks after stem cell transplant. Imaging showed signs of markedly elevated intracranial pressure, including optic disc protrusion, bilateral proptosis, and narrowing of dural venous sinuses. Lumbar puncture confirmed high opening pressure and mild pleocytosis, with headache and nausea improving after the procedure. Subsequent CSF and serum testing identified human herpesvirus 6 (HHV-6), confirming acute HHV-6 encephalitis. He was treated with ganciclovir and foscarnet, with persistent viral detection and elevated pressure after three weeks, eventually clearing HHV-6 from the CSF after ongoing therapy and serial lumbar punctures.<br /><br />HHV-6 is most commonly associated with roseola but can also cause severe illness, including febrile syndromes, seizures, hepatitis, pneumonia, myocarditis, and meningoencephalitis. The virus can remain latent in host cells and reactivate in immunocompromised patients, especially 2–6 weeks after bone marrow or stem cell transplant. In transplant patients, CNS HHV-6 infection often presents with altered mental status, memory loss, seizures, or focal deficits, though headache and lethargy may be prominent.<br /><br />First-line treatment includes ganciclovir and/or foscarnet for at least three weeks, with duration guided by clinical improvement and clearance of HHV-6 DNA. The key takeaway is that headache and lethargy after transplant should prompt urgent evaluation for life-threatening causes, including HHV-6 encephalitis, and pediatric hospitalists should be familiar with this post-transplant complication.

Asset Subtitle

Jaclyn Vargas

Meta Tag

Author List Calvin Lau, Jaclyn Vargas

Category Clinical Vignettes

Concept HHV-6 Encephalitis

Concept HHV-6

Concept Stem Cell Transplantation

Concept Immunocompromised State

Concept Central Nervous System Involvement

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Jaclyn Vargas

Track Pediatric

Keywords

HHV-6 encephalitis

stem cell transplant

intracranial pressure

X-linked lymphoproliferative syndrome

ganciclovir

foscarnet

post-transplant complication

lumbar puncture

immunocompromised host

pediatric hospitalist

HHV-6 Encephalitis

HHV-6

Stem Cell Transplantation

Immunocompromised State

Central Nervous System Involvement