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Analysis of five cases of human herpesvirus-6 myelitis among 121 cord blood transplantations

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Abstract

Reports of myelitis associated with human herpesvirus-6 (HHV-6) following allogeneic transplantation are rare. Of 121 cases of cord blood transplantation (CBT) performed at Nagano Red Cross Hospital, five cases (4.1%) of HHV-6 myelitis developed at around the time of engraftment. The major symptom identified in all five patients was superficial pain or pruritus linked to segmental levels of the spinal cord. Other identified symptoms were fever or low-grade fever in all five patients, autonomic nerve disorder in four patients, bladder and rectal disturbance in two patients, and extrapyramidal disorder in two patients. These symptoms were experienced primarily 16–39 days after CBT. HHV-6 PCR tests were all positive for cerebrospinal fluid and for plasma. Of the four cases tested by magnetic resonance imaging (MRI), three showed spinal cord abnormality. Antiviral therapy using foscarnet or ganciclovir was effective in every case. Although one case treated from 12 days after onset experienced long-term pain resembling postherpetic neuralgia, symptoms in the four cases were completely relieved after antiviral therapy. In summary, the major symptoms of HHV-6 myelitis were superficial pain linked to segmental levels of the spinal cord. Prognosis may be improved by early initiation of antiviral therapy.

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Authors and Affiliations

  1. Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan

    Toshimitsu Ueki, Yuki Hiroshima, Masahiko Sumi, Naoaki Ichikawa & Hikaru Kobayashi

  2. Department of Neurology, Nagano Red Cross Hospital, Nagano, Japan

    Kenichi Hoshi

  3. Department of Hematology, Faculty of Medicine, Oita University, Oita, Japan

    Masao Ogata & Takako Satou

  4. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

Authors
  1. Toshimitsu Ueki
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  2. Kenichi Hoshi
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  3. Yuki Hiroshima
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  4. Masahiko Sumi
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  5. Naoaki Ichikawa
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  6. Masao Ogata
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  7. Takako Satou
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  9. Hikaru Kobayashi
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Correspondence to Toshimitsu Ueki.

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The authors report no financial relationship with any company that has a direct financial interest in the subject matter or products discussed in the submitted manuscript, or with any company that produces a competing product.

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Ueki, T., Hoshi, K., Hiroshima, Y. et al. Analysis of five cases of human herpesvirus-6 myelitis among 121 cord blood transplantations. Int J Hematol 107, 363–372 (2018). https://doi.org/10.1007/s12185-017-2347-5

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  • DOI: https://doi.org/10.1007/s12185-017-2347-5

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