Exanthem subitum (human herpesvirus-6 reactivation) after autologous stem cell transplantation.

We present the case of a 62-year-old man treated with high-dose chemotherapy and consecutive autologous stem cell transplantation for mantle cell lymphoma, who developed high fever and a rash of the trunk and both axillae 10 days after stem cell transplantation.

Del síntoma a la enfermedad: elevación de transaminasas / From the symptom to the disease: increased transaminases

La transaminitis (elevación de AST-ALT) es un hallazgo habitual en la práctica clínica pediátrica. En ocasiones, su detección se produce en pacientes de cualquier edad sin síntomas de enfermedad hepática o biliar, tras una analítica solicitada por otro motivo. Se presenta el caso clínico de una niña de 9 años, a la que se realiza una analítica para intentar llegar al diagnóstico etiológico de una reacción cutánea. Esta reacción apareció en el transcurso de un tratamiento antibiótico instaurado por una neumonía. Tras el hallazgo de hipertransaminemia y su posterior confirmación en analíticas posteriores, se aplica el protocolo de estudio y es diagnosticada de enfermedad de Wilson (AU)

Increased transaminases (AST-ALT) is a common finding in paediatric clinical practice. Sometimes detection occurs in patients of any age with no symptoms of liver or biliary disease, following an analytical requested for another reason. We report the case of a 9 year old girl, on whom analytical tests were performed in an attempt to establish the aetiology of a skin reaction. This reaction appeared during a course of an antibiotic treatment for pneumonia. After elevated transaminases and subsequent confirmation in subsequent analytical, applies the study protocol and is diagnosed with Wilson's disease (AU)

HHV-6 infection - not only tertian fever.

The primary infection with the human herpesvirus (HHV) 6 usually occurs before the age of two (95%) and clinically either presents as tertian fever followed by exanthem subitum (10%) or even more often as febrile disease without an exanthem. In adults an active HHV-6 infection can present as febrile illness. A 19-year-old immunocompetent patient presented with high fever, exanthem, swelling of the lymph nodes and pancytopenia and was serologically diagnosed as active HHV-6 infection with anti- HHV-6-IgM- and -IgG antibodies. Since the antibodies were already detectable on day 5 of disease, with persistence of high IgG and undetectable IgM after 4 weeks, a reactivation seemed most likely. There was no evidence for an underlying immunosuppressive disease or reactivation induced by viral co-infection. Fulminant hepatitis or meningoencephalitis are the most frequent complications in immunocompetent individuals and have to be recognized at an early stage.

Drug-induced hypersensitivity syndrome with rapid hematopoietic reconstitution during treatment for acute myeloid leukemia.

Drug-induced hypersensitivity syndrome (DIHS) is a rare but severe life-threatening, drug-induced, systemic hypersensitivity reaction. We report two patients who developed DIHS during treatment for acute myeloid leukemia. Awareness of DIHS is necessary when systemic eruptions and high fever occur in leukemic patients, especially with rapid hematopoietic recovery after chemotherapies.

Salazosulfapyridine induced hypersensitivity syndrome associated with reactivation of humanherpes virus 6.

A 22-year-old woman with ulcerative colitis developed skin eruptions, liver dysfunction, and atypical lymphocytes in the peripheral blood two weeks after she started taking salazosulfapyridine (SASP). Skin eruptions and liver damage were severe. Drug-induced lymphocyte stimulation test (DLST) for SASP was positive. She was diagnosed as having SASP-induced hypersensitivity syndrome (HS). Corticosteroid therapy was needed to suppress these reactions. The transient elevation of HHV-6 IgG titer paralleled the symptoms, which indicated that these reactions were associated with the reactivation of HHV-6. We suggest that HHV-6 IgG titer is one of the modalities for the diagnosis and the prediction of the clinical course of HS.

HHV-6, 7 and their related diseases.

Human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) are relatively recently discovered beta-herpesvirus. They are prevalent in the human population. Primary infection of HHV-6 has been associated with exanthem subitum and febrile illness. Little information is known about the clinical characteristics of primary infection with HHV-7, although some cases of exanthem subitum have been linked to it. HHV-6 has been recently recognized as an opportunistic pathogen in patients with HIV infection and in transplant recipients. The techniques now available to detect these two viruses remain limited, though putative roles for HHV-6 and HHV-7 in several diseases linked to viral infection have been reported. This report reviews the current knowledge of HHV-6 and HHV-7 biology and their pathogenesis.

[Macrophage activation syndrome in primary human herpes virus-6 infection: a rare condition after liver transplantation in infants]. / Syndrome d'activation macrophagique au cours de la primo-infection pat le 6e virus herpétique humain: une affection certainement méconnue au cours de la transplantation hépatique chez l'enfant.

Human herpes virus-6 primary infection generally occurs during the first three years of childhood and is generally asymptomatic. The virus has been identified as the causal agent of exanthemum subitum in children or mononucleosis-like disease in adults, and may also cause several disorders in immunocompromised patients. We report a clinical case of acute rejection observed 29 days after orthotopic liver transplantation in a 22-month-old child associated with acute hepatitis and a hemophagocytic syndrome on day 38. Human herpes virus-6 primary infection was identified based on several virological tests: seroconversion, detection of viral DNA in bone marrow and peripheral blood after polymerase chain reaction, and detection of viral replication in peripheral blood. Tests for Epstein-Barr virus, cytomegalovirus or Parvovirus B19 infections were negative. After treatment by ganciclovir (Cymévan(R)), clinical status improved.

Apresentacao clinica de 52 criancas com exantema causado pelo Herpesvirus Humano tipo 6 / Clinical profile of 52 children with exhantem caused by human herpvirus type 6

Os autores descrevem e analisam manifestacoes clinicas observadas em criancas com exantema causado pelo Herpesvirus tipo 6. Foi realizado estudo prospectivo no Servico de Pronto-Atendimento Pediatrico do Hospital Universitario da USP, durante 15 meses, com as criancas que apresentavam exantema generalizado nao-bolhoso. Os pacientes deste grupo inicial foram examinados e receberam um diagnostico clinico previo. Destas criancas, foram incluidas na casuistica do presente estudo apenas as criancas menores de tres anos, que tivessem comprovacao laboratorial da presenca do Herpesvirus tipo 6 no sangue. O estudo laboratorial foi realizado atraves da reacao de polimerizacao em cadeia do acido nucleico do Herpesvirus humano tipo 6, em linfocitos de sangue periferico...

Childhood exanthems.

Childhood exanthems are a common cause of skin disease in children. Several new aspects of exanthems are reviewed. Two conditions, unilateral laterothoracic exanthem and asymmetric periflexural exanthem, may be variations of the same disease and could potentially represent a cutaneous reaction to several infectious agents. An eruption that has been called papular-purpuric gloves and socks syndrome is usually, but not invariably, caused by parvovirus B19 infection. Another unusual exanthem, eruptive pseudoangiomatosis, is also discussed. Finally, several new developments in the etiology and disease spectrum of exanthem subitum are emphasized.

Meningitis caused by human herpesvirus-6.

Since the discovery of human herpesvirus-6 (HHV-6) the illnesses associated with it have increased steadily. Two infants with meningitis are reported: both suffered a mild meningitis and serological studies confirmed an acute HHV-6 infection. This report supports a role of HHV-6 in nervous system disease.

[How often can the clinical diagnosis of exanthema subitum be confirmed with the HHV-6 serology test]. / Wie häufig kann die klinische Diagnose des Dreitagefiebers mit der HHV-6-Serologie bestätigt werden?

Three years ago a newly recognized human herpes virus (HHV-6) was identified to be the causative agent for exanthem subitum (roseola infantum). So far this diagnosis was suggested chiefly by excluding other infections and the presence of a typical course of the disease. To find out how often the clinical diagnosis can be confirmed serologically, we asked five pediatricians in private practice as well as residents of the out-patient and infant departments of our hospital to obtain paired heparinized blood samples of any child suspicious for exanthem subitum. 36 children with clinically suspected exanthem subitum and a mean age of 14.2 (5-71) months were included in this prospective study. Indirect immunofluorescence was used to detect IgG and IgM antibodies to HHV-6. In 22 children (61%) the clinical diagnosis was confirmed serologically. IgM antibody was found in only 16 of these 22 children. In 8 patients the results were ambiguous. Three had in the same time a doubtful seroconversion to other viruses of the herpes group (HSV twice; EBV once), in four children there was an insufficient rise in IgG antibodies without presence of an IgM response, and once we found a very high HHV-6 specific antibody titre (greater than 1:80) in both serum samples. In 6 children neither a seroconversion nor a rise in HHV-6 antibody titre were found. Retrospectively, only three of these children had a clinical course really typical for exanthem subitum. We conclude that in most cases the clinical diagnosis of exanthem subitum will be confirmed by serological examination.(ABSTRACT TRUNCATED AT 250 WORDS)