A Rare Case of HHV-6 Encephalitis in an Immunocompetent Host: Case Report and Literature Review.

Human herpesvirus-6 (HHV-6) is a virus known for causing the highly contagious infection, roseola infantum, and has been associated with causing encephalitis in pediatric patients and less commonly in adult patients as well. Regardless of the patient's age, the primary HHV-6 infection could be complicated by neurological sequelae including encephalitis, acute encephalopathy with biphasic seizures syndrome, or demyelinating disease. HHV-6 encephalitis does occur in an adult as a primary infection or reactivation. However, immunocompromised, hematopoietic stem cell transplantation patients, and solid organ transplant recipients are the most affected population. Here we present a rare case of HHV-6 encephalitis in a 26-year-old healthy immunocompetent male. HHV-6 viral DNA was detected in the cerebrospinal fluid during the acute stage of the disease, and the diagnosis was confirmed by quantitative polymerase chain reaction (PCR). The patient was treated with ganciclovir and had a complete response to treatment without any further complication. The pathophysiology, clinical course, and treatment in otherwise immunocompetent adult patients are also discussed.

A Rare Case of Listeria Septicemia and Meningitis in Liver Cirrhosis.

BACKGROUND Sepsis is a leading global cause of mortality, with the most common causative agents being Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli. In septic patients with liver cirrhosis, the mortality rates are higher than in the general population due to altered liver function and an excessive innate immune response. In this demographic, sepsis is typically caused by spontaneous bacterial peritonitis or urinary tract infections and the causative agents are very predictable owing to known dysregulated immunological pathways studied in patients with cirrhosis. Listeria monocytogenes is not only a less common cause of sepsis, but also a rare cause in patients with cirrhosis. Moreover, concurrent meningitis and septicemia is even less common in this demographic. CASE REPORT Herein we present a patient with known liver cirrhosis from chronic alcohol use who presented with generalized complaints and was admitted to the Intensive Care Unit with septic shock and concomitant liver failure. Although his changes in mentation were initially attributed to sepsis with superimposed hepatic encephalopathy, he was also diagnosed with meningitis. Cultures from the cerebral spinal fluid and blood serum were positive for Listeria monocytogenes. The patient's family reported that he had not recently consumed deli meat, cheeses, or raw chicken, and there were no known outbreaks in the area at the time of diagnosis. CONCLUSIONS This report illustrates a rare case of concurrent septicemia and meningitis secondary to Listeria monocytogenes in a patient with liver cirrhosis and reviews current literature.

Erdheim-Chester disease presenting at the central nervous system.

Erdheim-Chester disease is a rare non-Langerhans cell histiocytosis (LCH) that affects different body systems. It was recently recognized as a neoplastic disorder after identifying an activating mutation of the MAPK pathway. Neurological presentations of ECD are rare. We present a case of a 35-year-old male who presented to the emergency department with neck pain, headache and vomiting for 2 months; MRI showed multiple heterogeneous intracranial masses. Neurosurgery performed a suboccipital craniotomy, partially resected the cerebellar mass, and placed a parietal to frontal shunt catheter. Biopsy results from the cerebellar mass demonstrated cerebellar tissue involved by a diffuse proliferation of foamy histiocytes and spindle cells admixed with prominent lymphoplasmacytic infiltrate and positive for CD68, CD163, Factor XIIIa and Fascin. PET scan showed hypermetabolic uptake within the medullary portions of the diffuse abnormal lesions of the distal femurs, tibias, and fibulas, and cardiac MRI was nonsignificant. The patient was started on vemurafenib and continued to show improvement in a 3-month outpatient follow-up.