HHV-6 found in spinal fluid of an immunocompetent patient with possible temporal lobe epilepsy and post-ictal psychosis

A case report suggests the possibility that HHV-6 encephalitis may be the cause of a temporal lobe epilepsy-like episode with associated psychosis.

There is evidence linking HHV-6 to febrile seizures in childhood, and to some cases of mesial temporal lobe epilepsy. Stover et. al (2021 ) of the Western Michigan Homer Stryker School of Medicine report a case in which HHV-6 was found in spinal fluid of patient with possible TLE followed by possible post-ictal psychosis. 

A 58 year old male was hospitalized twice over the course of two weeks with confusion, reduced consciousness, aphasia, nausea, headache, personality changes, and new onset psychosis. He had a past history of major depression, diabetes, the use of cannibis and an unintended 23 Kg weight loss over the preceding 6 months.

Lumbar puncture was PCR positive for HHV-6 and acyclovir was started. Resolution of symptoms occurred in 5 days and the patient was discharged on acyclovir, only to be readmitted for another psychotic episode. Electroencephalogram (EEG) revealed sharp left temporal waves during drowsiness and sleep, suggestive of focal epileptiform discharges without clinical seizures, consistent with TLE. Valproate and olanzapine were started for epilepsy and agitation, which resolved the mental symptoms within a week. 

The authors felt that the positive response to antiviral therapy as well as positive HHV-6 CSF PCR suggested HHV-6 encephalitis as the possible cause of the symptoms, and the EEG abnormalities. However, the authors note that diagnostic testing was incomplete and that other factors could have played a role, such as the use of cannabis was, volatile  blood sugar levels, unintended substantial weight loss or possible that compromised immunity; no systematic assessment was performed to determine the patient’s immunocompetence. 

Read the full article: Stover 2021