A Single-Center Prospective Longitudinal Study of 92 Patients

A Single-Center Prospective Longitudinal Study of 92 Patients

Gastrointestinal complications are frequent after allogeneic stem cell transplantation (allo-SCT). Patients with neurologic symptoms and HHV-6 DNA in CSF without identification of an alternative etiology were categorized as having HHV-6 CNS dysfunction. Zerr and colleagues studied a cohort of 277 healthy infants from birth to two years of age to track HHV-6 acquisition and presentation. Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal severe cutaneous reaction, which has a delayed onset after the initiation of an inciting medication. HHV6 DNA was detected in PBMC of 15 patients and in CSF cell pellet of seven. Thus, this syndrome should be regarded as a reaction induced by a complex interplay among several herpesviruses (EB virus, HHV-6, HHV-7, and cytomegalovirus), antiviral immune responses, and drug-specific immune responses. Human herpesvirus 6 infection was demonstrated in 6 of 7 patients.

A Single-Center Prospective Longitudinal Study of 92 Patients
The manifestation of symptoms was of more frequent occurrence in patients with concurrent infection. During the methylprednisolone taper, our patient experienced symptom exacerbation, acute hepatitis, and HHV-6 seroconversion, indicating HHV-6 reactivation as the cause. However, most of these studies have yielded conflicting data. Endoscopic findings in these patients included biliary complications in 10 patients and gastritis in 2 patients. Informed consent was obtained from all subjects donating specimens in the course of this research. Serology is of limited use in the context of immunosuppression. Further studies are needed to define the significance of HHV-6 for GI tract symptoms after allo-SCT.

There is a dearth of data regarding the frequency of HHV-6 DNA detection in CSF in the absence of associated CNS dysfunction; two studies found this to occur in 0-0.9% of immunocompromised patients [6,7]. Thirty-eight percent of symptomatic infants with HHV-6 were examined by a physician for the illness. Patients and study design. From January 1997 through January 1998, 92 consecutive and unselected patients who were undergoing allogeneic (28 patients) or autologous (64 patients) stem cell transplantation at Nantes University Hospital, Nantes, France, were enrolled in this prospective longitudinal study. Patient characteristics are shown in table 1. Patients were examined for active HHV-6 infection once during the 20 days preceding transplantation and either once a week or twice a month during the first 100 days after transplantation (postprocedure follow-up period ranged from 28 to 200 days; median, 93 days). At each follow-up point, PBMC were tested for the presence of HHV-6 DNA.

During the methylprednisolone taper, our patient experienced symptom exacerbation, acute hepatitis, and HHV-6 seroconversion, indicating HHV-6 reactivation as the cause.

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