肝移植术后人疱疹病毒6B型脑炎的多学科综合诊疗

Multi-disciplinary team of human herpes virus-6B encephalitis after liver transplantation

目的通过多学科综合诊疗(MDT)模式提高肝移植术后人疱疹病毒6B(HHV-6B)型脑炎诊治的效果。方法对1例罕见的肝移植术后HHV-6B型脑炎的病人进行MDT讨论,以制定有效的个体化治疗方案。结果肝移植术后第16日,病人出现头痛症状,第18日突然出现反应迟钝、神志不清、昏迷,伴不自主的四肢抽搐。血氨升高,头颅CT检查提示脑缺血性改变,脑电图检查提示癫痫发作。经MDT讨论,考虑肝移植术后神经系统感染,予以药物控制癫痫发作,行腰椎穿刺进行脑脊液检查,提示颅内压升高,脑脊液实时荧光定量聚合酶链反应(RT-qPCR)检测到HHV-6B核酸阳性,证实为HHV-6B型脑炎。调整免疫抑制剂,静脉给予更昔洛韦抗病毒治疗,同时积极防治并发症。4 d后癫痫发作症状消失,2周后神经系统症状明显改善。抗病毒治疗4周后病毒学检测结果为阴性,病人神经功能恢复正常。结论成人肝移植术后HHV-6B型脑炎罕见,多与免疫抑制剂使用后的病毒再激活有关,通过MDT模式可更全面了解病人的病情,制定更有效的个体化治疗方案,提高治疗的有效性及安全性。

Objective To evaluate the role of multi-disciplinary team(MDT)in improving the diagnosis and treatment of human herpes virus-6 B(HHV-6 B)encephalitis after liver transplantation.Methods MDT consultation was delivered for one rare case of HHV-6 B encephalitis after liver transplantation to establish an effective individualized treatment regime.Results On the 16 d after liver transplantation,the patient developed headache,and suddenly presented with unresponsiveness,unconsciousness,coma complicated with involuntary limb twitching on the 18 d.Blood ammonia level was increased.Brain CT scan showed cerebral ischemic changes.Electroencephalography prompted the epileptic seizure.After MDT consultation,the possibility of nervous system infection after liver transplantation was considered,and medication therapy was given to control the epileptic seizure.Cerebrospinal fluid examination via lumbar puncture hinted increased intracranial pressure.Real-time fluorescent quantitative polymerase chain reaction(RT-qPCR)of the cerebrospinal fluid demonstrated that the patient was tested positive for HHV-6 B nucleic acid,which confirmed the diagnosis of HHV-6 B encephalitis.The immunosuppressant regime was adjusted,intravenous ganciclovir was given for antiviral treatment,and active interventions were delivered to prevent and treat relevant complications.Epileptic seizure disappeared after 4 d,and neurological symptoms were significantly alleviated after 2 weeks.After 4-week antiviral treatment,the patient was tested negative for virology testing,and the neurological function was restored to normal.Conclusions HHV-6 B encephalitis rarely occurs after adult liver transplantation,which is primarily associated with the virus reactivation after use of immunosuppressant.MDT pattern may be employed to deepen the understanding of the patient’s condition,formulate more effective individualized treatment regime,and enhance the clinical efficacy and safety.