异基因造血干细胞移植后人类疱疹病毒7型病毒性脑炎三例并文献复习

Human herpesvirus 7 viral encephalitis after allogeneic hematopoietic stem cell transplantation:report of three cases and review of literature

目的探讨异基因造血干细胞移植(allo-HSCT)后人类疱疹病毒7型(HHV-7)病毒性脑炎患者的临床特征、诊断、治疗和转归。方法回顾性分析河北燕达陆道培医院2018年至2020年收治的3例接受allo-HSCT后发生HHV-7病毒性脑炎患者的临床表现、实验室特征、诊治经过及转归,并复习相关文献。结果3例接受allo-HSCT后发生HHV-7病毒性脑炎患者的临床表现包括发热、头痛、呕吐、神志淡漠等,无特异性症状和体征。脑脊液常规白细胞计数可正常或稍高,以淋巴细胞为主,脑脊液蛋白可正常或轻度增高,脑脊液HHV-7病毒DNA阳性,应用更昔洛韦或膦甲酸钠治疗有效。2例轻症患者预后好,1例合并脑出血患者死亡。结论HHV-7病毒性脑炎是allo-HSCT后的一种少见感染,因缺乏典型症状和常规实验室检查指征而易被漏诊,脑脊液中检测出HHV-7 DNA可帮助确诊,目前尚无标准治疗方案,更昔洛韦、膦甲酸钠治疗有效。

Objective To investigate the clinical characteristics,diagnosis,treatment and outcome of patients with human herpesvirus 7(HHV-7)viral encephalitis after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods The clinical manifestations,laboratory characteristics,diagnosis and treatment process and outcome of 3 patients with HHV-7 viral encephalitis after allo-HSCT in Hebei Yanda Lu Daopei Hospital from 2018 to 2020 were retrospectively analyzed,and the related literature was reviewed.Results The clinical features of 3 patients with HHV-7 viral encephalitis after allo-HSCT included fever,headache,vomiting,apathy,etc.,without specific symptoms or signs.The conventional white blood cell count in the cerebrospinal fluid was normal or slightly higher,mainly lymphocytes,and the cerebrospinal fluid protein was normal or slightly higher.The HHV-7 virus DNA in cerebrospinal fluid was positive,and the treatment with ganciclovir or foscarnet was effective.The prognosis was favorable in two mild cases,but one case with cerebral hemorrhage died eventually.Conclusions HHV-7 viral encephalitis is a rare infection after allo-HSCT,and it can be easily misdiagnosed due to lack of typical symptoms and indications for routine laboratory tests.The detection of HHV-7 DNA in the cerebrospinal fluid can help confirm the diagnosis.Currently,there is no standard treatment programs,but ganciclovir and foscarnet are effective.