Background

The most common causative pathogen of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) was reported as HHV-6. Although excitotoxic injury with delayed neuronal death is considered to be a possible pathogenesis of AESD, the detailed pathophysiology remains unclear.

Case presentation

We present a twelve-month-old girl with AESD due to HHV-6 primary infection. She was successfully treated for AESD including targeted temperature management and the administration of vitamin B1, B6, and L-carnitine. Although the viral load of HHV-6 in her liquor was high (12,000 copies/mL), she fully recovered without antiviral agent use.

Discussion

There has been no study focusing on the HHV-6 viral load in patients with AESD, and only a few case reports have been published. We reviewed the clinical features and viral load in the liquor of our case and four reported infants with AESD due to HHV-6 primary infection who had real-time PCR tests results. Viral loads in the three patients with a poor prognosis were 31.5, negative, and 3,390 copies/mL, respectively. On the other hand, the copy numbers of HHV-6 DNA in the two patients with no sequelae were 12,000 and 106 copies/mL, respectively, and our case had the highest viral load among the five summarized patients.

中文翻译：

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降低白酒中 HHV-6 病毒载量对皮疹引起的 AESD 严重程度的影响：病例报告和文献回顾

背景

据报道，伴有双相性癫痫发作和晚期弥散性降低 (AESD) 的急性脑病最常见的致病病原体是 HHV-6。尽管延迟神经元死亡的兴奋性毒性损伤被认为是 AESD 的可能发病机制，但详细的病理生理学仍不清楚。

案例展示

我们介绍了一名因 HHV-6 原发感染而患有 AESD 的 12 个月大女孩。她成功接受了 AESD 治疗，包括有针对性的温度管理和维生素 B1、B6 和左旋肉碱的给药。尽管她的酒中 HHV-6 的病毒载量很高（12,000 拷贝/mL），但她在没有使用抗病毒剂的情况下完全康复。

讨论

目前还没有关于 AESD 患者 HHV-6 病毒载量的研究，也只有少数病例报告发表。我们回顾了我们病例酒液中的临床特征和病毒载量，并报告了 4 名因 HHV-6 原发性感染而患有 AESD 的婴儿，他们获得了实时 PCR 检测结果。3 名预后不良患者的病毒载量分别为 31.5、阴性和 3,390 拷贝/mL。另一方面，两名无后遗症患者的 HHV-6 DNA 拷贝数分别为 12,000 和 106 拷贝/mL，我们的病例在总结的五名患者中病毒载量最高。