E46 Viruses reactivating each other’s!

Abstract

Abstract Introduction COVID-19 is known to cause an immunocompromised state. This condition was associated with reactivation of quiescent viruses. Objectives Describe a case of HHV-6 reactivation in a patient diagnosed with MIS-C syndrome. Methods The diagnosis of MIS-C syndrome associated to SARS-CoV-2 was done by following the criteria established by the World Health Organization (WHO). The reactivation of HHV6 was confirmed by positivity of RT-PCR in blood and presence of IgG in serology. Results A four years old girl, with no medical history who presented to emergency room with high fever associated with conjunctival injection, cheilitis, cervical adenopathy and rash since four days. She developed a generalized tonic-clonic seizure then a vasoplegic shock two days later. Thus, she was admitted in ICU. Clinical examination on admission showed polypnea, a low blood oxygen level, tachycardia, a low blood pressure (28/15mmhg), a hepatomegaly, a maculopapular rash in pelvic region and a bilateral eyelid swelling. Biology showed lymphopenia (660 109/l), hepatic cytolysis, low prothrombin test (19%), an acute renal failure, a biological inflammatory syndrome with an elevated C-reactive protein (274 mg/l), an elevated ferritin, increased d-dimers (1µg/ml) and fibrinogen level which suggest activation of the coagulation cascade with a prothrombotic state and elevated lactatemia (6.4 mmol/l). The chest X-ray was normal. She had a low ejection fraction (39%) showed on echocardiogram. A rapid SARS-CoV-2 test was negative but serology was positive. Since MIS-C syndrome was not known to give severe hepatitis, other diagnoses was proposed. RT-PCR in serum associated to RT-PCR in cutaneous lesion’s biopsy was positive for HHV6. The hepatitis A serology was negative. She has an anterior immunity to varicella-zoster (VZV). She was intubated. She received vasoactive medications, intravenous immunoglobulin (IVIG) and steroids. Course was marked by hemolytic anaemia, which was associated to immunoglobulin (IVIG). Our patient become rapidly afebrile. Vital signs and laboratory parameters of inflammation, CRP, lymphopenia, markers of cardiac injury, transaminases and renal function parameters all normalized. On day 28 of hospital stay, she was discharged with full dose of steroids and low dose of aspirin. Conclusion HHV6 reactivation needs a state of immunosuppression and was reported with acquired immunodeficiency syndrome (AIDS) and a variety of lymphoproliferative disorders. It leads to fever, cutaneous eruption as well as more serious complication such as hepatitis, which is the case with our patient. Ethics No conflicts of interest.