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Fatal outcome after reactivation of inherited chromosomally integrated HHV‐6A (iciHHV‐6A) transmitted through liver transplantation |
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| Authors: | P. Bonnafous J. Marlet D. Bouvet E. Salamé A.‐C. Tellier S. Guyetant A. Goudeau H. Agut A. Gautheret‐Dejean C. Gaudy‐Graffin |
| Affiliation: | 1. Sorbonne Université, Faculté de médecine, INSERM, CIMI‐Paris U1135, Equipe PVI, F‐75013 Paris, France;2. Morphogenèse et Antigénicité du VIH et des Virus des Hépatites Tours, Inserm U1259, Université de Tours, Tours, France;3. Laboratoire de Bactériologie‐Virologie‐Hygiène, CHU de Tours, Tours, France;4. Unité de Chirurgie Hépato‐Biliaire et pancréatique‐Transplantation hépatique, CHU de Tours, Tours, France;5. Réanimation Chirurgicale Tours, CHU de Tours, Tours, France;6. Service d'Anatomie et Cytologie Pathologiques, CHU de Tours, Tours, France;7. Service de Virologie HU La Pitié Salpêtrière‐Charles Foix Paris, APHP, Paris, France;8. Laboratoire de Microbiologie Paris, équipe UPRES EA4065, Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France |
| Abstract: | HHV‐6A and HHV‐6B are found as inherited and chromosomally integrated forms (iciHHV‐6A and ‐6B) into all germinal and somatic cells and vertically transmitted in a Mendelian manner in about 1% of the population. They were occasionally shown to be horizontally transmitted through hematopoietic stem cell transplantation. Here, we present a clinical case of horizontal transmission of iciHHV‐6A from donor to recipient through liver transplantation. Molecular analysis performed on three viral genes (7.2 kb) in the recipient and donor samples supports transmission of iciHHV‐6A from the graft. Transmission was followed by reactivation, with high viral loads in several compartments. The infection was uncontrollable, leading to severe disease and death, despite antiviral treatments and the absence of resistance mutations. This case highlights the fact that physicians should be aware of the possible horizontal transmission of iciHHV‐6 and its consequences in case of reactivation in immunocompromised patients. |
| Keywords: | clinical research/practice immunosuppressant immunosuppression/immune modulation infection and infectious agents ‐ viral: human herpesvirus 6 (HHV‐6) infection and infectious agents ‐ viral infectious disease liver transplantation/hepatology |