Annals of Indian Academy of Neurology
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Year : 2015  |  Volume : 18  |  Issue : 4  |  Page : 455-456

HHV-6 associated fulminant encephalo-myocarditis in an immunocompetent individual

Department of Neurology, Lead Consultant Neurologist, Aster Medcity, Kothad, Kochi, Kerala, India

Date of Submission30-May-2015
Date of Decision22-Jun-2015
Date of Acceptance23-Jun-2015
Date of Web Publication17-Nov-2015

Correspondence Address:
Boby Varkey Maramattom
Lead Consultant Neurologist, Aster Medcity, Kothad, Kochi-682 027, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-2327.169650

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How to cite this article:
Maramattom BV. HHV-6 associated fulminant encephalo-myocarditis in an immunocompetent individual. Ann Indian Acad Neurol 2015;18:455-6

How to cite this URL:
Maramattom BV. HHV-6 associated fulminant encephalo-myocarditis in an immunocompetent individual. Ann Indian Acad Neurol [serial online] 2015 [cited 2020 Jan 22];18:455-6. Available from:

A 64-year-old immuno-competent man developed fever and altered sensorium of 2 days duration. Cerebrospinal fluid (CSF) showed 40 cells [P30%, L70%], normal glucose and protein levels. Magnetic resonance imaging (MRI) showed right mesial temporal hyperintensity [Figure 1]. Cerebrospinal fluid-polymerase chain reaction (CSF-PCR) was positive for Human Herpes Virus 6 {HHV-6} on day 5 and negative for herpes simplex virus (HSV), enteroviruses and other viruses by PCR panel [Xcyton AES, Bangalore]. ECG showed sinus tachycardia, extensive ST-T changes, cardiac biomarkers were elevated [CK-MB 85 U/l, Troponin I, 0.4 U], and echocardiogram showed global hypokinesia suggestive of myocarditis [Video 1]. Increasing dyspnea necessitated mechanical ventilation and he expired on day 7. Primary infection with HHV-6 occurs in >95% of individuals by the age of 2 years. HHV-6-associated encephalitis, limbic encephalitis, or myocarditis are well described in both immunocompromised patients and immuno-competent patients. [1],[2],[3] Imaging features suggestive of limbic encephalitis should prompt testing for HHV-6 in addition to HSV or paraneoplastic encephalitis. [4] An encephalo-myocarditis syndrome may also be present.
Figure 1: Axial diffusion weighted MRI (DW MRI) and fl uid attenuated inversion recovery MRI (FLAIR) MRI images and Coronal FLAIR MRI images show a right mesial temporal hyperitensity

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   References Top

Bhanushali MJ, Kranick SM, Freeman AF, Cuellar-Rodriguez JM, Battiwalla M, Gea-Banacloche JC, et al. Human herpes 6 virus encephalitis complicating allogeneic hematopoietic stem cell transplantation. Neurology 2013;80:1494-500.  Back to cited text no. 1
Mahrholdt H, Wagner A, Deluigi CC, Kispert E, Hager S, Meinhardt G, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 2006;114:1581-90.  Back to cited text no. 2
McCullers JA, Lakeman FD, Whitley RJ. Human herpesvirus 6 is associated with focal encephalitis. Clin Infect Dis 1995;21:571-6.  Back to cited text no. 3
Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A, et al, International Encephalitis Consortium. Case definitions, diagnostic algorithms, and priorities in encephalitis: Consensus statement of the international encephalitis consortium. Clin Infect Dis 2013;57:1114-28.  Back to cited text no. 4


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