Journal
TRANSPLANT IMMUNOLOGY
Volume 76, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.trim.2022.101742
Keywords
Human herpesvirus-6; Umbilical cord blood transplant; Hyponatremia; Post-transplant acute limbic encephalitis
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This article reports a rare case of persistent hyponatremia in a stem-cell transplant recipient infected with human herpesvirus-6 (HHV-6). The patient's hyponatremia and HHV-6 viremia improved with water-restriction, tolvaptan, and a combination of foscarnet and ganciclovir. However, recurrent HHV-6 infections with persistent hyponatremia required continued treatment with foscarnet.
Long-term neurocognitive deficits after human herpesvirus-6 (HHV-6) infection are common in stem-cell transplant recipients, but SIADH (Syndrome of inappropriate antidiuretic hormone secretion) with persistent hyponatremia is rare. A 51-year-old woman presented with somnolence, hyponatremia (121 mmol/L) and HHV-6 viremia (80,330 copies/ml) on day +22 post umbilical cord blood transplant (UCBT). With waterrestriction, tolvaptan and combination of foscarnet and ganciclovir, patient's hyponatremia and HHV-6 viremia improved. On day +94 UCBT, hyponatremia and HHV-6 viremia recurred. Foscarnet was restarted and continued until day +269 UCBT due to multiple HHV-6 recurrences with persistent hyponatremia. At day +712, patient remains on water-restriction, tolvaptan for continuous hyponatremia from SIADH.
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