A group of researchers from Sao Paulo, Brazil reported on the development of HHV-6 infection in the striatum of a 32-year-old man with diffuse large B-cell non-Hodgkin’s lymphoma. Six weeks after allogeneic hematopoietic stem cell transplantation, he developed progressive bilateral bradykinesia, rest tremor, upper limbs rigidity, and disorientation. Upon neurologic examination, global Parkinsonism, symmetric hyperreflexia, and cognitive dysfunction were found. HHV-6 DNA was detected in both plasma and cerebrospinal fluid by PCR. No other viral or bacterial infections were found. After being treated with intravenous ganciclovir, (5 mg/kg twice daily for 21 days) the patient demonstrated improvement in disorientation and a repeat CSF HHV-6 DNA PCR was negative at two weeks. The Parkinsonism persisted and an MRI at three months showed mild putaminal and caudate atrophy.
The authors believe that the presence of HHV-6 in the striatal lesion is likely as HHV-6 was detected in the CSF by PCR (log 5 copies/ml). This is the first reported case of HHV-6 infection affecting the striatum and presenting with Parkinsonism post-HSCT.
For more information, read the full paper: Cury 2015