Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Sep 24;8(11):ofab470.
doi: 10.1093/ofid/ofab470. eCollection 2021 Nov.

HHV-6 Encephalitis After Chimeric Antigen Receptor T-cell Therapy (CAR-T): 2 Case Reports and a Brief Review of the Literature

Melanie T Rebechi  1 , Jacqueline T Bork  1   2 , David J Riedel  1   2
Affiliations
Case Reports

HHV-6 Encephalitis After Chimeric Antigen Receptor T-cell Therapy (CAR-T): 2 Case Reports and a Brief Review of the Literature

Melanie T Rebechi et al. Open Forum Infect Dis. .

Abstract

Human herpesvirus 6 (HHV-6) reactivation can occur in patients who are highly immunosuppressed, including those who have undergone hematopoietic stem cell transplantation (HSCT). HHV-6 encephalitis is a severe manifestation that is well described in the HSCT population. Chimeric antigen receptor T-cell (CAR-T) therapy is a novel cancer-directed immunotherapy that results in severe immunosuppression. Patients undergoing CAR-T therapy may be at risk for HHV-6 encephalitis, which can be difficult to distinguish from a common adverse effect of CAR-T therapy, neurotoxicity. Herein, we describe 2 patients diagnosed with HHV-6 encephalitis after CAR-T therapy and discuss the diagnostic approach and differential diagnosis for altered mental status after CAR-T therapy. Diagnosing HHV-6 encephalitis can be difficult in this patient population as altered mental status is common after CAR-T therapy and may be attributed to CAR-T-associated neurotoxicity.

Keywords: 6 encephalitis; CAR; HHV; T; cell therapy; chimeric antigen receptor T; human herpesvirus 6.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Patient 1 MRI with mild bilateral symmetric areas of T2/FLAIR increased signal within bilateral hippocampi. Abbreviations: MRI, magnetic resonance imaging; T2/FLAIR, T2-weighted fluid attenuated inversion recovery.
Figure 2.
Figure 2.
Patient 2 MRI with mild diffuse FLAIR hyperintensity in the periventricular white matter and brainstem. Abbreviations: FLAIR, ; MRI, magnetic resonance imaging.
See this image and copyright information in PMC

References

    1. Pantry SN, Medveczky PG. Latency, integration, and reactivation of human herpesvirus-6. Viruses 2017; 9: 194. - PMC - PubMed
    1. Zerr DM, Boeckh M, Delaney C, et al. HHV-6 reactivation and associated sequelae after hematopoietic cell transplantation. Biol Blood Marrow Transplant 2012; 18:1700–8. - PMC - PubMed
    1. Zerr DM, Corey L, Kim HW, et al. Clinical outcomes of human herpesvirus 6 reactivation after hematopoietic stem cell transplantation. Clin Infect Dis 2005; 40:932–40. - PubMed
    1. Ljungman P, Wang FZ, Clark DA, et al. High levels of human herpesvirus 6 DNA in peripheral blood leucocytes are correlated to platelet engraftment and disease in allogeneic stem cell transplant patients. Br J Haematol 2000; 111:774–81. - PubMed
    1. Yoshikawa T, Asano Y, Ihira M, et al. Human herpesvirus 6 viremia in bone marrow transplant recipients: clinical features and risk factors. J Infect Dis 2002; 185:847–53. - PubMed

Publication types