Case Report: A rare cause of multiple organ dysfunction syndrome: Human Herpes Virus 6 infection [version 1; referees: 1 approved, 1 approved with reservations]

Human herpes virus 6 (HHV-6) is a member of the β-herpes virus subfamily which targets mainly CD4 T cells and is a well-known cause of roseola infantum. Fever without roseola, encephalitis and hepatitis however are not uncommon after HHV-6 infection. More severe clinical cases are commonly observed in immune compromised patients. Case: An 11-month old girl, after a 24-hour fever, and with poor appetite was admitted into the hospital. Oral antibiotic treatment was initiated and she was discharged from the state hospital’s out-patient clinic two hours later. The following day, the patient continued to experience high fever, and hematemesis, and a tendency to sleep were added to her condition and she was once more admitted to the hospital. Lab results showed thrombocytopenia, alanine aminotransferase over 3000 U/L, INR was 2.5 and urea and creatinine were elevated at 75 mg/dl and 1.1 mg/dl, respectively. Due to persistent high fever and somnolence, a lumbar puncture was performed. The cerebrospinal fluid (CSF) was clear of any cells; protein and glucose were within normal range. However, test results were positive for HHV-6 DNA in the CSF, serum, and lymphocytes. Four organ dysfunctions including the central nervous-, hematologic-, renal- and hepatic systems, developed because of HHV-6 infection. Organ functions were normalized within one week of supportive treatment. HHV-6 is a benign virus that very rarely causes severe infection and hardly ever leads to a fatal infection. However, in our case, a healthy child, with a HHV- viral infection led to multiple organ dysfunction without any predisposing reason.