DOI: 10.12890/2026_007465

Probable HHV-6 limbic encephalitis after liver transplantation: diagnostic overlap with tacrolimus neurotoxicity and refractory status epilepticus

Authors

  • Shunsuke Kondo Department of Internal Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, USA
  • Scott T. Nishioka Department of Internal Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, USA
  • Joshua J. Garcia Department of Internal Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, USA
  • Brent K. Tatsuno Department of Internal Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, USA; Division of Pulmonary and Critical Care, Department of Medicine, The Queen’s Medical Center, Honolulu, USA

h26ms.kondo@gmail.com

Keywords

Human herpesvirus 6, HHV-6 encephalitis, liver transplantation, status epilepticus, Immunosuppression

Abstract

Human herpesvirus 6 (HHV-6) encephalitis is an uncommon but severe post-transplant complication. A 64-year-old woman developed confusion, behavioural changes, and staring episodes 6 months after liver transplantation. Cerebrospinal fluid (CSF) multiplex testing was positive for HHV-6, and magnetic resonance imaging showed bilateral hippocampal and mesial temporal abnormalities, later involving the bitemporal and insular regions. Her course was complicated by refractory status epilepticus, cardiac arrest, kidney injury, prolonged ventilation, pancytopenia, recurrent HHV-6 positivity, and death. This case highlights the challenge of interpreting CSF HHV-6 positivity amid competing diagnoses and the treatment burden imposed by antiviral and antiseizure drug toxicity.

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References

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Published

2026-10-19

Issue

2026: LATEST ONLINE

Categories

How to Cite

1.
Kondo S, Garcia JJ, Tatsuno BK. Probable HHV-6 limbic encephalitis after liver transplantation: diagnostic overlap with tacrolimus neurotoxicity and refractory status epilepticus. EJCRIM [Internet]. 2026 Oct. 19 [cited 2026 Nov. 3];13. Available from: https://ejcrim.com/index.php/ejcrim/article/view/7465

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