HHV-6に Table EB-VCA: HA: EB-viral-capsid-antigen hepatitis Fig. 1 A virus EBNA: HSV: herpes Atypical lymphocyte EB virus simplex 1 Laboratory nuclear

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Key words: infectious mononucleosis-like syndrome, human herpes virus-6

HHV-6に Table EB-VCA: HA: EB-viral-capsid-antigen hepatitis Fig. 1 A virus EBNA: HSV: herpes Atypical lymphocyte EB virus simplex 1 Laboratory nuclear virus in the peripheral 265 よ る伝 染 性 単 核 球 症 様症 候 群 CMV: data antigen cytomegalo blood virus 倍 と な り,そ の 後 も高 値 が 持 続 した(Fig.2).こ こ と か ら も,今 回 の 症 状 がHHV-6感 の 染 に関連 し た も の で あ っ た こ とが 強 く示 唆 され た. 考 察 伝 染 性 単 核 球 症 様 の 臨 床 像 を 示 し なが ら もEB ウ イ ル ス 感 染 の 証 明 で き ない 症 例 が あ る こ と は 以 前 か ら知 られ て お り,伝 染 性 単 核 球 症 様 症 候 群 と して 報 告 さ れ る こ と が あ っ た.そ の な か に はサ イ トメ ガ ロ ウ イ ル ス や単 純 ヘ ル ペ ス ウ イ ル ス の 関 与 す る 症 例 が あ る こ と も知 られ て い る.自 験 症 例 で は これ らの い ず れ の ウ イ ル ス抗 体 価 も変 動 を示 さ ず,HHV-6に 対 す る抗 体 の み が 急 性 感 染 を示 唆 す る 有 意 な 変 動 を示 した. HHV-6はAIDSに ろ,IgM抗 体 は3月5日 低 下 した.IgG抗 平 成12年3月20日 に160倍 ま で 上 昇 した 後 体 は 上 昇 を 続 け,4月3日2,560 と も な う リ ンパ 増 殖 性 病 変 か ら初 め て 分 離 され た ウ イ ル ス で あ り1),の ち に 小 児 の 突 発 性 発 疹2)や熱 性 痙 攣3)の原 因 と な る こ と

Fig. 2 Clinical course

encephalitis due to variant B human herpesvirus- 6 in a bone marrow transolant recipient. N Eng J Med 1994; 330: 1356-1360. 10) Bertram G, Dreiner N, Krueger GRF et al.: Fre- quent double infection with Epstein-Barr virus and human herpesvirus-6 in patients with acute infectious mononucleosis. In Vivo 1991; 5: 271-280. 11) Akashi K, Eizuru Y, Sumiyoshi Y et al.: Severe infectious mononucleosis like syngrome and primary human herpesvirus 6 infection. N Eng J Med 1993; 329: 168-171. 12) Niederman JC, Liu C-R, Kaplan NH, Brown NA: Clinical and serological features of human her- 1) Salahuddin SZ, Ablashi DV, Markham PD et al.: Isolation of new virus, HBLV, in patients with lymphoproliferative disorders. Science 1986; 234: 596-601. 2) Yamanishi K, Okuno T, Shiraki K et al.: Identification of human herpesvirus-6 as a causal agent for exanthem subitum. Lancet 1988; 1: 1065-1067. 3) Purksananonda P, Hall CB, Insel RA et al.: Primary human herpesvirus 6 infection in young children. N Eng J Med 1991; 326: 1445-1450. 4) Briggs M, Fox J, Tedder RS: Age preverence of antibody to human herpesvirus 6. Lancet 1988; 1: 1058-1059. 5) Okuno T, Takahashi K, Balachandra K et al.: Seroepidemiology of human herpesvirus 6 infection in normal children and adults. J Clin Microbiol 7) Yoshikawa T, Suga S, Asano Y et al. : Human herpesvirus-6 infection in bone marrow transplantation. Blood 1991; 78: 1381-1384. 8) Carrigan DR, Drobyski WR, Russler SK et al.: Interstitial pneumonitis associated with human herpesvirus-6 infection after marrow transplantation. Lancet 1991; 338: 147-149. 9) Drobyski WR, Knox KK, Majewski D et al.: Fetal pesvirus-6 infection in three adults. Lancet 1988; 2: 817-819. 13) Sumiyoshi Y, Akashi K, Kikuchi M: Detection of human herpes virus 6 (HHV6) in the skin of a patient with primary HHV 6 infection and erythroderma. J Clin Pathol 1994; 47: 762-763. 14) Sumiyoshi Y, Kikuchi M, Ohshima K, Yakeshita M, Eizuru Y, Minamishima Y: A case of human herpesvirus-6 lymphadenitis with infectious mononucleosis like syndrome. Pathol Int 1995; 45: 947-951. 15) Morris DJ: Primary human herpesvirus 6 infection in an adult. N Eng J Med 1993; 329: 1817-1818. 16) Kondo K, Hayakawa Y, Mori H et al.: Detection by polymerase chain reacrtion amplification of human herpesvirus-6 DNA in peripheral blood of patients with exanthem subitum. J Clin Microbiol 1990; 28: 970-974. 1989; 27: 651-653. 17) Desscamps V, Bouscarat F, Laglenne S et al.: Human Herpesvirus 6 infection associated with anticonvulsant hypersensitivity syndrome and reactive haemophagocytic syndrome. Br J Dermatol 1997; 137: 605-608.

A Case with Infectious Mononucleosis-like Syndrome Caused by Human Herpes Virus-6 Infection Takayuki KARIN01), Naoko ASAOKA1), Takako SUNAGAWAn, Hideo OHBA1), Hirohide YONEYAMA1), Yoshihiro KOBASHI1), Jiro OKIMOTOn & Rinzo SOEJIMA2) A 26-year-old female was admitted because of multiple fractures in lower extremities. While in the hospital, she developed a high fever and generalized skin eruption. Physical examination revealed bilateral cervical lymphadenopathy and mild hepatosplenomegaly. The white cell count was 11,200 with 11% atypical lymphocytes. Serum GOT, GPT, LDH were markedly elevated. Infectious mononucleosis was suspected, but the serological test for EB virus did not show evidence of acute EB virus infection. Anti-HSV, CMV, hepatitis A virus antibody titers also did not show significant change during the coarse. The serological test for HHV-6 only showed increased titer of IgM and IgG antibodies. Rapidly elevated IgG antibody titer was indicative of reactivation of HHV-6. So, she was diagnosed as mononucleosis-like syndrome caused by HHV-6, probably reactivated infection. Her symptoms gradually disappeared during a month.

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