Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Successful treatment of an HHV6B-induced diarrhea with ganciclovir in a patient after PBSCT

Bone Marrow Transplantation volume 43, pages 87–88 (2009)Cite this article

We report a case of a 24-old patient suffering from HHV6-induced diarrhea after allogeneic SCT. HHV6 is known to cause exanthema subitum in children,1 a febrile disease associated with a typical rash. Like all herpes viruses HHV6 persists after primary infection for the rest of the life and is usually controlled by the immune system. In an immunocompromised patient HHV6 can reactivate with fever and skin rash2 too but also cause more severe illness. Cases of interstitial pneumonitis,3 encephalitis,4 myelosuppression5 and a possible association with GVHD6 have been reported. In addition, reports on HHV6-induced diarrhea7 have been published.

Our patient was allografted with 7.62 × 106 CD34+ cells per kg from a matched unrelated donor following myeloablative conditioning therapy (BU 16 mg/kg, VP-16 30 mg/kg, CY 120 mg/kg, anti-thymocyte globulin 6 mg/kg) for consolidation therapy of a Burkitt-like lymphoma in second remission. The second remission was obtained by high-dose therapy consisting of carboplatin 1500 mg/m2, ifosfamide 14 g/m2 and VP-16 1500 mg/m2 and autologous stem cell reinfusion. CYA was given for GVHD prophylaxis. Acyclovir prophylaxis (3 × 400 mg per day) was initiated on day +1. Leukocyte engraftment (>1.0 Gpt/l) occurred on day +15. On day +19 after transplantation he developed fever up to 39.6 °C followed by massive watery diarrhea with stool volumes up to 4000 ml per day. Leukocyte count decreased from 7.45 to 1.92 Gpt/l and a maculopapular exanthem was seen simultaneously. As the diagnosis of acute GVHD was most likely, a gastroscopy and a colonoscopy were performed. Multiple biopsies from stomach, duodenum and colon were obtained. Histopathology showed the picture of an unspecific colitis but no signs of an intestinal GVHD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Yamanishi K, Okuno T, Shiraki K, Takahashi M, Kondo T, Asano Y et al. Identification of human herpesvirus-6 as a causal agent for exanthem subitum. Lancet 1988; 1: 1065–1067.

    Article  CAS  PubMed  Google Scholar 

  2. Yoshikawa T, Suga S, Asano Y, Nakashima T, Yazaki T, Sobue R et al. Human herpesvirus-6 infection in bone marrow transplantation. Blood 1991; 78: 1381–1384.

    CAS  PubMed  Google Scholar 

  3. Cone RW, Hackman RC, Huang ML, Bowden RA, Meyers JD, Metcalf M et al. Human herpesvirus 6 in lung tissue from patients with pneumonitis after bone marrow transplantation. N Engl J Med 1993; 329: 156–161.

    Article  CAS  PubMed  Google Scholar 

  4. Drobyski WR, Knox KK, Majewski D, Carrigan DR . Brief report: fatal encephalitis due to variant B human herpesvirus-6 infection in a bone marrow-transplant recipient. N Engl J Med 1994; 330: 1356–1360.

    Article  CAS  PubMed  Google Scholar 

  5. Drobyski WR, Dunne WM, Burd EM, Knox KK, Ash RC, Horowitz MM et al. Human herpesvirus-6 (HHV-6) infection in allogeneic bone marrow transplant recipients: evidence of a marrow-suppressive role for HHV-6 in vivo. J Infect Dis 1993; 167: 735–739.

    Article  CAS  PubMed  Google Scholar 

  6. Appleton AL, Sviland L, Peiris JS, Taylor CE, Wilkes J, Green MA et al. Human herpes virus-6 infection in marrow graft recipients: role in pathogenesis of graft-versus-host disease. Newcastle upon Tyne Bone Marrow Transport Group. Bone Marrow Transplant 1995; 16: 777–782.

    CAS  PubMed  Google Scholar 

  7. Amo K, Tanaka-Taya K, Inagi R, Miyagawa H, Miyoshi H, Okusu I et al. Human herpesvirus 6B infection of the large intestine of patients with diarrhea. Clin Infect Dis 2003; 36: 120–123.

    Article  PubMed  Google Scholar 

  8. Collot S, Petit B, Bordessoule D, Alain S, Touati M, Denis F et al. Real-time PCR for quantification of human herpesvirus 6 DNA from lymph nodes and saliva. J Clin Microbiol 2002; 40: 2445–2451.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Hentrich M, Oruzio D, Jäger G, Schlemmer M, Schleuning M, Schiel X et al. Impact of human herpesvirus-6 after haematopoietic stem cell transplantation. Br J Haematol 2005; 128: 66–72.

    Article  PubMed  Google Scholar 

  10. Tokimasa S, Hara J, Osugi Y, Ohta H, Matsuda Y, Fujisaki H et al. Ganciclovir is effective for prophylaxis and treatment of human herpesvirus-6 in allogeneic stem cell transplantation. Bone Marrow Transplant 2002; 29: 595–598.

    Article  CAS  PubMed  Google Scholar 

  11. Pöhlmann C, Schetelig J, Reuner U, Bornhäuser M, Illmer T, Kiani A et al. Cidofovir and foscarnet for treatment of human herpesvirus 6 encephalitis in a neutropenic stem cell transplant recipient. Clin Infect Dis 2007; 44: e118–e120.

    Article  PubMed  Google Scholar 

  12. Singh N, Carrigan DR . Human herpesvirus-6 in transplantation: an emerging pathogen. Ann Intern Med 1996; 124: 1065–1071.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Haematology and Oncology, Transplant Centre, Internal Medicine C, Ernst-Moritz-Arndt University, Greifswald, Germany

    T Neumann, W H Krüger, T Kiefer, F Schüler & G Dölken

  2. Friedrich-Loeffler-Institute for Medical Microbiology, Ernst-Moritz-Arndt University, Greifswald, Germany

    K Zimmermann

Authors
  1. T Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W H Krüger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Zimmermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T Kiefer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F Schüler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G Dölken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W H Krüger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Neumann, T., Krüger, W., Zimmermann, K. et al. Successful treatment of an HHV6B-induced diarrhea with ganciclovir in a patient after PBSCT. Bone Marrow Transplant 43, 87–88 (2009). https://doi.org/10.1038/bmt.2008.272

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2008.272

Search

Advanced search

Quick links