Human pegivirus identified in severe myelitis and optic neuritis in immunocompromised patients: A pathogenic role for a forgotten virus?

The role of Human pegivirus (HPgV) in patients with encephalitis has been recently questioned. We present cases of 4 patients with similar clinical, biological, and radiological characteristics, including a past history of transplantation with long-term immunosuppres-sion and a progressive course of severe and predominantly myelitis, associated in 3 cases with optic neuropathy causing blindness. Extensive workup was negative but analysis of the CSF by use of pan-microorganism DNA-and RNA-based shotgun metagenomics was positive for HPgV. This case series further supports the hypothesis of HPgV CNS infection and highlights the utility of metagenomic next-generation sequencing of CSF in immuno-compromised patients.(c) 2022 Published by Elsevier Masson SAS.

Automated summary

This study reports 4 cases of patients with similar clinical, biological, and radiological characteristics, including a history of transplantation with long-term immunosuppression and a progressive course of severe myelitis, and in 3 cases, optic neuropathy causing blindness. Extensive workup was negative but pan-microorganism DNA- and RNA-based shotgun metagenomics analysis of the cerebrospinal fluid (CSF) was positive for Human pegivirus (HPgV). This case series further supports the hypothesis of HPgV CNS infection and highlights the utility of metagenomic next-generation sequencing of CSF in immuno-compromised patients.