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J Clin Virol. 2016 Apr;77:63-5. doi: 10.1016/j.jcv.2016.02.001. Epub 2016 Feb 11.

Acute myelitis by human herpes virus 7 in an HIV-infected patient.

Author information

1
Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain. Electronic address: alfesvi@gmail.com.
2
Department of Neurology, Hospital Ramón y Cajal, Ctra. de Colmenar Km. 9, 100, 28034 Madrid, Spain.
3
Department of Microbiology Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) and CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.

Abstract

BACKGROUND:

HHV7 reactivation has been occasionally reported as a cause of encephalitis or myelitis in transplant recipients, but to our knowledge it has never been associated with neurological disease in HIV-infected patients. We report a case of acute myelitis in an HIV-infected patient, with sustained HHV-7 DNA amplification in cerebrospinal fluid (CSF) and a favourable response to foscarnet.

CASE REPORT:

A 40 year-old man with HIV infection was admitted with asymmetric hypoesthesia in legs and paraparesis. He was receiving treatment with efavirenz, emtricitabine and tenofovir, his CD4 count was 580/mm3 and HIV viral load was undetectable. Magnetic resonance imaging showed a focal central hyperintensity on T2 and STIR sequences, on the torathic spinal cord, with slight enhancement after intravenous gadolinium. All microbiological studies were negative except for HHV-7 DNA amplification in CSF. With a diagnosis of idiopathic transverse myelitis, treatment with high-dose intravenous methylprednisolone was initiated. However, paraparesis continued worsening, and a second CSF obtained 12 days after the first one resulted again in HHV-7 amplification.

RESULTS:

The patient was treated with a 2 week course of foscarnet, and a rapid neurological improvement was noted. After treatment, PCR for HHV-7 in CSF was negative. Neurological exam was normal one month after treatment initiation.

CONCLUSION:

HHV-7 reactivation may cause neurological disease in patients with HIV infection. Foscarnet is an effective treatment in HHV-7 associated myelitis.

KEYWORDS:

Foscarnet; HIV; Human herpesvirus-7; Myelitis

PMID:
26906233
DOI:
10.1016/j.jcv.2016.02.001
[Indexed for MEDLINE]

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