Human herpes virus-6 encephalitis causing severe anterograde amnesia associated with rituximab, azathioprine and prednisolone combination therapy for dermatomyositis
Human herpes virus-6 (HHV-6) reactivation is a well-recognised complication following haematological stem cell transplantation, but it is novel in the context of combination immunomodulatory therapy for autoimmune disease. We report a case of severe anterograde amnesia caused by HHV-6 encephalitis i...
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| Veröffentlicht in: | Journal of neurovirology 2017-06, Vol.23 (3), p.508-510 |
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| creator | Baumer, Thomas Fry, Charlie Luppe, Sebastian Gunawardena, Harsha Sieradzan, Kasia |
| description | Human herpes virus-6 (HHV-6) reactivation is a well-recognised complication following haematological stem cell transplantation, but it is novel in the context of combination immunomodulatory therapy for autoimmune disease. We report a case of severe anterograde amnesia caused by HHV-6 encephalitis in a young female patient on rituximab, azathioprine and prednisolone for dermatomyositis (DM). The use of targeted biologic treatments for systemic autoimmune connective tissue diseases (CTDs) is increasing, particularly when refractory to conventional management. The anti-CD20 B cell depleting monoclonal antibody, rituximab is now increasingly used, often in combination with conventional immunomodulatory treatments, in certain autoimmune neurological conditions and systemic CTDs including DM. Physicians should be aware of the possibility of HHV-6 in those who develop encephalitis while CD20 B cell deplete, especially in the presence of additional immunomodulatory therapies. Prompt diagnosis and treatment of HHV-6 encephalitis with evidence-based anti-viral therapy may help reduce the extent of irreversible morbidity such as amnesia. |
| doi_str_mv | 10.1007/s13365-017-0517-0 |
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We report a case of severe anterograde amnesia caused by HHV-6 encephalitis in a young female patient on rituximab, azathioprine and prednisolone for dermatomyositis (DM). The use of targeted biologic treatments for systemic autoimmune connective tissue diseases (CTDs) is increasing, particularly when refractory to conventional management. The anti-CD20 B cell depleting monoclonal antibody, rituximab is now increasingly used, often in combination with conventional immunomodulatory treatments, in certain autoimmune neurological conditions and systemic CTDs including DM. Physicians should be aware of the possibility of HHV-6 in those who develop encephalitis while CD20 B cell deplete, especially in the presence of additional immunomodulatory therapies. Prompt diagnosis and treatment of HHV-6 encephalitis with evidence-based anti-viral therapy may help reduce the extent of irreversible morbidity such as amnesia.</description><identifier>ISSN: 1355-0284</identifier><identifier>EISSN: 1538-2443</identifier><identifier>DOI: 10.1007/s13365-017-0517-0</identifier><identifier>PMID: 28224486</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acyclovir - therapeutic use ; Adult ; Amnesia, Anterograde - drug therapy ; Amnesia, Anterograde - etiology ; Amnesia, Anterograde - immunology ; Amnesia, Anterograde - virology ; Antiviral Agents - therapeutic use ; Azathioprine - adverse effects ; B-Lymphocytes - drug effects ; B-Lymphocytes - immunology ; B-Lymphocytes - pathology ; Biomedical and Life Sciences ; Biomedicine ; Case Report ; Dermatomyositis - drug therapy ; Dermatomyositis - immunology ; Dermatomyositis - pathology ; Encephalitis, Viral - complications ; Encephalitis, Viral - drug therapy ; Encephalitis, Viral - immunology ; Encephalitis, Viral - virology ; Female ; Herpesvirus 6, Human - genetics ; Herpesvirus 6, Human - isolation & purification ; Humans ; Immunologic Factors - adverse effects ; Immunology ; Infectious Diseases ; Lymphocyte Depletion ; Neurology ; Neurosciences ; Penicillanic Acid - analogs & derivatives ; Penicillanic Acid - therapeutic use ; Piperacillin - therapeutic use ; Prednisolone - adverse effects ; Rituximab - adverse effects ; Roseolovirus Infections - complications ; Roseolovirus Infections - drug therapy ; Roseolovirus Infections - immunology ; Roseolovirus Infections - virology ; Virology</subject><ispartof>Journal of neurovirology, 2017-06, Vol.23 (3), p.508-510</ispartof><rights>Journal of NeuroVirology, Inc. 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c344t-45cca069f65a52906032412e64bfc1420368eee94bf907626619bc2b70fde1503</citedby><cites>FETCH-LOGICAL-c344t-45cca069f65a52906032412e64bfc1420368eee94bf907626619bc2b70fde1503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s13365-017-0517-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s13365-017-0517-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28224486$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baumer, Thomas</creatorcontrib><creatorcontrib>Fry, Charlie</creatorcontrib><creatorcontrib>Luppe, Sebastian</creatorcontrib><creatorcontrib>Gunawardena, Harsha</creatorcontrib><creatorcontrib>Sieradzan, Kasia</creatorcontrib><title>Human herpes virus-6 encephalitis causing severe anterograde amnesia associated with rituximab, azathioprine and prednisolone combination therapy for dermatomyositis</title><title>Journal of neurovirology</title><addtitle>J. Neurovirol</addtitle><addtitle>J Neurovirol</addtitle><description>Human herpes virus-6 (HHV-6) reactivation is a well-recognised complication following haematological stem cell transplantation, but it is novel in the context of combination immunomodulatory therapy for autoimmune disease. We report a case of severe anterograde amnesia caused by HHV-6 encephalitis in a young female patient on rituximab, azathioprine and prednisolone for dermatomyositis (DM). The use of targeted biologic treatments for systemic autoimmune connective tissue diseases (CTDs) is increasing, particularly when refractory to conventional management. The anti-CD20 B cell depleting monoclonal antibody, rituximab is now increasingly used, often in combination with conventional immunomodulatory treatments, in certain autoimmune neurological conditions and systemic CTDs including DM. Physicians should be aware of the possibility of HHV-6 in those who develop encephalitis while CD20 B cell deplete, especially in the presence of additional immunomodulatory therapies. Prompt diagnosis and treatment of HHV-6 encephalitis with evidence-based anti-viral therapy may help reduce the extent of irreversible morbidity such as amnesia.</description><subject>Acyclovir - therapeutic use</subject><subject>Adult</subject><subject>Amnesia, Anterograde - drug therapy</subject><subject>Amnesia, Anterograde - etiology</subject><subject>Amnesia, Anterograde - immunology</subject><subject>Amnesia, Anterograde - virology</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Azathioprine - adverse effects</subject><subject>B-Lymphocytes - drug effects</subject><subject>B-Lymphocytes - immunology</subject><subject>B-Lymphocytes - pathology</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Case Report</subject><subject>Dermatomyositis - drug therapy</subject><subject>Dermatomyositis - immunology</subject><subject>Dermatomyositis - pathology</subject><subject>Encephalitis, Viral - complications</subject><subject>Encephalitis, Viral - drug therapy</subject><subject>Encephalitis, Viral - immunology</subject><subject>Encephalitis, Viral - virology</subject><subject>Female</subject><subject>Herpesvirus 6, Human - genetics</subject><subject>Herpesvirus 6, Human - isolation & purification</subject><subject>Humans</subject><subject>Immunologic Factors - adverse effects</subject><subject>Immunology</subject><subject>Infectious Diseases</subject><subject>Lymphocyte Depletion</subject><subject>Neurology</subject><subject>Neurosciences</subject><subject>Penicillanic Acid - analogs & derivatives</subject><subject>Penicillanic Acid - therapeutic use</subject><subject>Piperacillin - therapeutic use</subject><subject>Prednisolone - adverse effects</subject><subject>Rituximab - adverse effects</subject><subject>Roseolovirus Infections - complications</subject><subject>Roseolovirus Infections - drug therapy</subject><subject>Roseolovirus Infections - immunology</subject><subject>Roseolovirus Infections - virology</subject><subject>Virology</subject><issn>1355-0284</issn><issn>1538-2443</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1TAQhS0EoqXwAGyQlywI-C-Os0QVUKRKbGBtOc7kXleJHTxO4fI-vCeObmHJxjO2vzmamUPIS87ecsa6d8il1G3DeNewdj8ekUveStMIpeTjmsu2_gqjLsgzxDvGuNTCPCUXwoiKGH1Jft9si4v0CHkFpPchb9hoCtHDenRzKAGpdxuGeKAI95CBulggp0N2Y82XCBgcdYjJB1dgpD9COdIcyvYzLG54Q90vV44hrTnEvXaka4YxBkxzqg8-LUOIroQUaalNuPVEp5TpCHlxJS2nhHsPz8mTyc0ILx7iFfn28cPX65vm9sunz9fvbxsvlSqNar13TPeTbl0reqaZFIoL0GqYPFeCSW0AoK_XnnVaaM37wYuhY9MIvGXyirw-6645fd8Ai10CephnFyFtaLnpWG9UZ0xF-Rn1OSFmmGwdcXH5ZDmzuzv27I6t7tjdHbvLv3qQ34YFxn8Vf-2ogDgDuO_rANnepS3HOvJ_VP8AIcKe_Q</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Baumer, Thomas</creator><creator>Fry, Charlie</creator><creator>Luppe, Sebastian</creator><creator>Gunawardena, Harsha</creator><creator>Sieradzan, Kasia</creator><general>Springer International Publishing</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Human herpes virus-6 encephalitis causing severe anterograde amnesia associated with rituximab, azathioprine and prednisolone combination therapy for dermatomyositis</title><author>Baumer, Thomas ; Fry, Charlie ; Luppe, Sebastian ; Gunawardena, Harsha ; Sieradzan, Kasia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c344t-45cca069f65a52906032412e64bfc1420368eee94bf907626619bc2b70fde1503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acyclovir - therapeutic use</topic><topic>Adult</topic><topic>Amnesia, Anterograde - drug therapy</topic><topic>Amnesia, Anterograde - etiology</topic><topic>Amnesia, Anterograde - immunology</topic><topic>Amnesia, Anterograde - virology</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Azathioprine - adverse effects</topic><topic>B-Lymphocytes - drug effects</topic><topic>B-Lymphocytes - immunology</topic><topic>B-Lymphocytes - pathology</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Case Report</topic><topic>Dermatomyositis - drug therapy</topic><topic>Dermatomyositis - immunology</topic><topic>Dermatomyositis - pathology</topic><topic>Encephalitis, Viral - complications</topic><topic>Encephalitis, Viral - drug therapy</topic><topic>Encephalitis, Viral - immunology</topic><topic>Encephalitis, Viral - virology</topic><topic>Female</topic><topic>Herpesvirus 6, Human - genetics</topic><topic>Herpesvirus 6, Human - isolation & purification</topic><topic>Humans</topic><topic>Immunologic Factors - adverse effects</topic><topic>Immunology</topic><topic>Infectious Diseases</topic><topic>Lymphocyte Depletion</topic><topic>Neurology</topic><topic>Neurosciences</topic><topic>Penicillanic Acid - analogs & derivatives</topic><topic>Penicillanic Acid - therapeutic use</topic><topic>Piperacillin - therapeutic use</topic><topic>Prednisolone - adverse effects</topic><topic>Rituximab - adverse effects</topic><topic>Roseolovirus Infections - complications</topic><topic>Roseolovirus Infections - drug therapy</topic><topic>Roseolovirus Infections - immunology</topic><topic>Roseolovirus Infections - virology</topic><topic>Virology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baumer, Thomas</creatorcontrib><creatorcontrib>Fry, Charlie</creatorcontrib><creatorcontrib>Luppe, Sebastian</creatorcontrib><creatorcontrib>Gunawardena, Harsha</creatorcontrib><creatorcontrib>Sieradzan, Kasia</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neurovirology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baumer, Thomas</au><au>Fry, Charlie</au><au>Luppe, Sebastian</au><au>Gunawardena, Harsha</au><au>Sieradzan, Kasia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Human herpes virus-6 encephalitis causing severe anterograde amnesia associated with rituximab, azathioprine and prednisolone combination therapy for dermatomyositis</atitle><jtitle>Journal of neurovirology</jtitle><stitle>J. Neurovirol</stitle><addtitle>J Neurovirol</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>23</volume><issue>3</issue><spage>508</spage><epage>510</epage><pages>508-510</pages><issn>1355-0284</issn><eissn>1538-2443</eissn><abstract>Human herpes virus-6 (HHV-6) reactivation is a well-recognised complication following haematological stem cell transplantation, but it is novel in the context of combination immunomodulatory therapy for autoimmune disease. We report a case of severe anterograde amnesia caused by HHV-6 encephalitis in a young female patient on rituximab, azathioprine and prednisolone for dermatomyositis (DM). The use of targeted biologic treatments for systemic autoimmune connective tissue diseases (CTDs) is increasing, particularly when refractory to conventional management. The anti-CD20 B cell depleting monoclonal antibody, rituximab is now increasingly used, often in combination with conventional immunomodulatory treatments, in certain autoimmune neurological conditions and systemic CTDs including DM. Physicians should be aware of the possibility of HHV-6 in those who develop encephalitis while CD20 B cell deplete, especially in the presence of additional immunomodulatory therapies. Prompt diagnosis and treatment of HHV-6 encephalitis with evidence-based anti-viral therapy may help reduce the extent of irreversible morbidity such as amnesia.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>28224486</pmid><doi>10.1007/s13365-017-0517-0</doi><tpages>3</tpages></addata></record> |
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| subjects | Acyclovir - therapeutic use Adult Amnesia, Anterograde - drug therapy Amnesia, Anterograde - etiology Amnesia, Anterograde - immunology Amnesia, Anterograde - virology Antiviral Agents - therapeutic use Azathioprine - adverse effects B-Lymphocytes - drug effects B-Lymphocytes - immunology B-Lymphocytes - pathology Biomedical and Life Sciences Biomedicine Case Report Dermatomyositis - drug therapy Dermatomyositis - immunology Dermatomyositis - pathology Encephalitis, Viral - complications Encephalitis, Viral - drug therapy Encephalitis, Viral - immunology Encephalitis, Viral - virology Female Herpesvirus 6, Human - genetics Herpesvirus 6, Human - isolation & purification Humans Immunologic Factors - adverse effects Immunology Infectious Diseases Lymphocyte Depletion Neurology Neurosciences Penicillanic Acid - analogs & derivatives Penicillanic Acid - therapeutic use Piperacillin - therapeutic use Prednisolone - adverse effects Rituximab - adverse effects Roseolovirus Infections - complications Roseolovirus Infections - drug therapy Roseolovirus Infections - immunology Roseolovirus Infections - virology Virology |
| title | Human herpes virus-6 encephalitis causing severe anterograde amnesia associated with rituximab, azathioprine and prednisolone combination therapy for dermatomyositis |
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