Presentation and Management of HHV6 Infection in a 32 Days Old Baby

Background: Human herpesvirus 6 (HHV-6), commonly known to cause the childhood disease roseola and nonspecific viral illness, has been known to cause serious neurological complications including fever induced seizures and encephalitis with possible long-term sequelae especially in immunocompromised patients. Purposes: To report a rare case of HHV-6 meningitis in a 32-day old male infant and the challenging therapeutic approach required to treat and manage this condition. Case summary: A 32-day old male infant presented with one episode of high-grade fever and bulging anterior fontanel in the absence of skin rashes. Blood tests were normal but lumbar puncture done at admission revealed lymphocytic pleocytosis secondary to acute HHV-6 confirmed by CSF PCR. Data indicating appropriate treatment in this age group is limited. In this case, the patient received Ganciclovir IV for 14 days and showed clinical improvement. Conclusion: Treatment of HHV-6 meningitis with ganciclovir is recommended for immunocompromised patients, including immune deficient patients, and those receiving chemotherapy or prolonged course of steroid. However, literature does not support any specific treatment for immunocompetent children. No data or clear recommendations are currently available for the treatment of neonates with HHV-6 meningitis. Should neonates be thought of as immunocompromised hosts and be treated with Ganciclovir or should they only receive supportive treatment? More studies are required to have an evidence based antiviral treatment in this age group.