Multi-disciplinary team of human herpes virus-6B encephalitis after liver transplantation
10.3969/j.issn.1674-7445.2021.04.014
- VernacularTitle:肝移植术后人疱疹病毒6B型脑炎的多学科综合诊疗
- Author:
Yafei GUO
1
;
Jizhou WANG
;
Zebin ZHU
;
Cui CHEN
;
Guoyan LIU
;
Sen QUN
;
Kexue DENG
;
Dehao HUANG
;
Lianxin LIU
Author Information
1. Organ Transplantation Center, the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), Hefei 230036, China
- Publication Type:Research Article
- Keywords:
Liver transplantation;
Human herpes virus;
Nervous system infection;
Encephalitis;
Epilepsy;
Lumbar puncture;
Polymerase chain reaction;
Multi-disciplinary team
- From:
Organ Transplantation
2021;12(4):465-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the role of multi-disciplinary team (MDT) in improving the diagnosis and treatment of human herpes virus-6B (HHV-6B) encephalitis after liver transplantation. Methods MDT consultation was delivered for one rare case of HHV-6B encephalitis after liver transplantation to establish an effective individualized treatment regime. Results On the 16 d after liver transplantation, the patient developed headache, and suddenly presented with unresponsiveness, unconsciousness, coma complicated with involuntary limb twitching on the 18 d. Blood ammonia level was increased. Brain CT scan showed cerebral ischemic changes. Electroencephalography prompted the epileptic seizure. After MDT consultation, the possibility of nervous system infection after liver transplantation was considered, and medication therapy was given to control the epileptic seizure. Cerebrospinal fluid examination via lumbar puncture hinted increased intracranial pressure. Real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) of the cerebrospinal fluid demonstrated that the patient was tested positive for HHV-6B nucleic acid, which confirmed the diagnosis of HHV-6B encephalitis. The immunosuppressant regime was adjusted, intravenous ganciclovir was given for antiviral treatment, and active interventions were delivered to prevent and treat relevant complications. Epileptic seizure disappeared after 4 d, and neurological symptoms were significantly alleviated after 2 weeks. After 4-week antiviral treatment, the patient was tested negative for virology testing, and the neurological function was restored to normal. Conclusions HHV-6B encephalitis rarely occurs after adult liver transplantation, which is primarily associated with the virus reactivation after use of immunosuppressant. MDT pattern may be employed to deepen the understanding of the patient's condition, formulate more effective individualized treatment regime, and enhance the clinical efficacy and safety.
