@article{3147244,
    title = "Human herpesvirus 6-related pure red cell aplasia, secondary graft
failure, and clinical severe immune suppression after allogeneic
hematopoietic cell transplantation successfully treated with foscarnet",
    author = "Lagadinou, E. D. and Marangos, M. and Liga, M. and Panos, G. and and Tzouvara, E. and Dimitroulia, E. and Tiniakou, M. and Tsakris, A. and and Zoumbos, N. and Spyridonidis, A.",
    journal = "Transplant Infectious Disease",
    year = "2010",
    volume = "12",
    number = "5",
    pages = "437-440",
    publisher = "Wiley",
    issn = "1398-2273, 1399-3062",
    doi = "10.1111/j.1399-3062.2010.00515.x",
    keywords = "HHV-6; HCT; PRCA; severe immune suppression; foscavir; foscarnet;
allogeneic hematopoietic cell transplant",
    abstract = "P>Human herpesvirus 6 (HHV-6) is frequently detected after allogeneic
hematopoietic cell transplantation (allo-HCT); however, the clinical
interpretation of HHV-6 viremia in a transplant patient is challenging
as it may signify asymptomatic reactivation, chromosomal integration of
the virus genome in the donor or recipient with no clinical
significance, or severe HHV-6 disease. Here we present a case of HHV-6
disease after allo-HCT presenting as pure red cell aplasia, secondary
graft failure, and severe immunosuppression causing multiple severe
bacterial super-infections. Examination of pre-transplant patient and
donor samples as well as serial determination of HHV-6 DNA copy numbers
after transplantation were necessary to definitively interpret HHV-6
viremia as active HHV-6 infection with a causative role in pancytopenia
and immune suppression. Foscarnet treatment resulted both in viral load
decline and disappearance of HHV-6-related bone marrow suppression and
predisposition to severe infections. Clinicians should be aware of the
wide array of clinical manifestations and the diagnostic pitfalls of
post-transplant HHV-6 disease. These issues are extremely challenging,
as they may result either in dangerous underestimation of HHV-6 disease
or in the institution of unnecessary antiviral therapy. Late bone marrow
aplasia and late severe infections after allo-HCT without other obvious
causes may be HHV-6 related."
}