case_images: PMC10937551_01
case_images: Timeline from the diagnosis of lymphoma, through the course of treatment, to the diagnosis of HHV6B encephalitis via lumbar puncture with mNGS. ASCT, Autologous Stem Cell Transplantation; auto, autologous; allo, allogeneic; LP, lumbar puncture; mos., months; d, day(s).
case_images: fneur-15-1334000-g001.jpg
case_images: PMC10937551_03_fneur-15-1334000-g001.jpg
case_images: fig1
case_images: Patient 3 was a 50-year-old female who experienced relapse after two lines of therapy (Table 1; Figure 1).
case_images: PMC10937551_02
case_images: Timeline from the diagnosis of lymphoma, through the course of treatment, to the diagnosis of HHV6B encephalitis via lumbar puncture with mNGS. ASCT, Autologous Stem Cell Transplantation; auto, autologous; allo, allogeneic; LP, lumbar puncture; mos., months; d, day(s).
case_images: fneur-15-1334000-g001.jpg
case_images: PMC10937551_03_fneur-15-1334000-g001.jpg
case_images: fig1
case_images: Patient 3 was a 50-year-old female who experienced relapse after two lines of therapy (Table 1; Figure 1).
case_images: Features of clinical presentations and laboratory examinations. (A) Clinical presentations of HHV6 reactivation patients; S, SCI, Stem Cell Infusion; (C), CTI; G, IVIgG. (B) mNGS of CSF samples of the patients. The identified sequence read numbers corresponding to HHV6B were 9,605, 41,626, and 126,904, with genomic coverages of 72.55, 83.32, and 87.5%, respectively. (C) Trends of cytokines both in serum and CSF. The units are as follows: IL2R: U/mL; IL1beta, IL6, IL8, IL10, TNFalpha: pg./mL. (D) Biochemistry results of CSF.
case_images: fneur-15-1334000-g002.jpg
case_images: PMC10937551_03_fneur-15-1334000-g002.jpg
case_images: fig2
case_images: The patient required high-activity antiviral therapy, combined ganciclovir (5 mg/kg, iv, q12h), and foscarnet (60 mg/kg, iv, q12h) until clearance of HHV6B DNA in the blood, additionally with IgG infusions for 7 days at acute-onset (Figure 2A). All three patients presented with a fever lasting at least 2 weeks and were resistant to low-activity antiviral and other antimicrobial regimens (Figure 2A) within 1 week after CTI. High loads of HHV6B were detected in all CSF samples (Figure 2B) using mNGS. As shown in Figure 2C, serum cytokine levels were also analyzed for correlation with those in the CSF. According to a previous study on HHV6B, CSF cell counts were often unremarkable, whereas the fold changes in glucose, lactate, and protein levels were extremely elevated relative to the lower reference values (Figure 2D, the actual values and reference ranges for each CSF component in Supplementary Table S2).
case_images: PMC10937551_03
case_images: Timeline from the diagnosis of lymphoma, through the course of treatment, to the diagnosis of HHV6B encephalitis via lumbar puncture with mNGS. ASCT, Autologous Stem Cell Transplantation; auto, autologous; allo, allogeneic; LP, lumbar puncture; mos., months; d, day(s).
case_images: fneur-15-1334000-g001.jpg
case_images: PMC10937551_03_fneur-15-1334000-g001.jpg
case_images: fig1
case_images: Patient 3 was a 50-year-old female who experienced relapse after two lines of therapy (Table 1; Figure 1).
case_images: Features of clinical presentations and laboratory examinations. (A) Clinical presentations of HHV6 reactivation patients; S, SCI, Stem Cell Infusion; (C), CTI; G, IVIgG. (B) mNGS of CSF samples of the patients. The identified sequence read numbers corresponding to HHV6B were 9,605, 41,626, and 126,904, with genomic coverages of 72.55, 83.32, and 87.5%, respectively. (C) Trends of cytokines both in serum and CSF. The units are as follows: IL2R: U/mL; IL1beta, IL6, IL8, IL10, TNFalpha: pg./mL. (D) Biochemistry results of CSF.
case_images: fneur-15-1334000-g002.jpg
case_images: PMC10937551_03_fneur-15-1334000-g002.jpg
case_images: fig2
case_images: The patient required high-activity antiviral therapy, combined ganciclovir (5 mg/kg, iv, q12h), and foscarnet (60 mg/kg, iv, q12h) until clearance of HHV6B DNA in the blood, additionally with IgG infusions for 7 days at acute-onset (Figure 2A). All three patients presented with a fever lasting at least 2 weeks and were resistant to low-activity antiviral and other antimicrobial regimens (Figure 2A) within 1 week after CTI. High loads of HHV6B were detected in all CSF samples (Figure 2B) using mNGS. As shown in Figure 2C, serum cytokine levels were also analyzed for correlation with those in the CSF. According to a previous study on HHV6B, CSF cell counts were often unremarkable, whereas the fold changes in glucose, lactate, and protein levels were extremely elevated relative to the lower reference values (Figure 2D, the actual values and reference ranges for each CSF component in Supplementary Table S2).