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Título

HUMAN HERPESVIRUS 7 (HHV-7) ENCEPHALITIS: A CASE REPORT

RESUMO

Case presentation: Female, 15 year-old, black, previously healthy and immunocompetent, presented to the emergency room with a history of fever, skin rash, headache, diarrhea, feet edema and polyarthritis in January/2022. On the neurological examination, she had drowsiness, mental confusion, psychomotor agitation, memory alteration, generalized motor epileptic seizures, visual field alterations, drooling, urinary incontinence, and objective muscle weakness. A syndromic diagnosis of encephalitis was given, and venous acyclovir was prescribed, with no improvement of the neurological condition. She was then referred to a tertiary hospital facility. On admission, no changes on the segmental physical examination were present. In the neurological examination, she had a Glasgow Coma Scale of 9 points, mental confusion, memory changes and global aphasia. Visual acuity examination, strength, sensitivity, and reflex were not able to be performed. There were no changes in pupillary reflex and ocular motility. She was then admitted to the intensive care unit and mechanical ventilation was started. Head CT, MRI and EEG were normal. Serum and cerebrospinal fluid (CSF) samples were negative for zika and chikungunya viruses and indeterminate for dengue fever virus by PCR method. Multiplex PCR, an exam to simultaneously identify human adenovirus, cytomegalovirus, enterovirus, erythrovirus B19, human herpesvirus 7 (HHV-7), human parechovirus, human herpesvirus 6, Epstein-Barr virus, herpes simplex virus 1, herpes simplex virus 3 and varicella-zoster virus, was performed and positive in the CSF for HHV-7 and negative for the others tested. Discussion and conclusion: Primary HHV-7 infection usually occurs during childhood and presents mainly as a sudden exanthema, with a later latency state and possible reactivation in immunodeficiency. However, although rare, cases of encephalitis and post-infectious autoimmune encephalitis related to HHV-7 in immunocompetent patients have already been reported in the literature. This possibility should be considered when the main causes of encephalitis are ruled out. In such cases, multiplex-PCR should be performed, allowing for a rapid and comprehensive etiological diagnosis.