Disclosures: Daniela A. Iliescu, MD: No financial relationships or conflicts of interest

Case Description: A 51-year-old male presented to PCP office with a two day history of blurry vision and diplopia. MRI showed minimal small vessel ischemic changes without any acute abnormality, and he was initiated on Prednisone and Acyclovir for presumed acute viral labyrinthitis. His dizziness, imbalance and nausea worsened and he presented to the ED two weeks later, where he was noted to have severe nystagmus and ataxia. Imaging was non-acute. Extensive neurologic and infectious workup returned positive only for Human Herpesvirus 6 (HHV-6) in the CSF, confirmed by microbiology. He was then initiated on IV Ganciclovir for treatment of HHV-6 meningoencephalitis.

Setting: Multidisciplinary Academic Center

Patient: A 51-year-old male with diagnosis of HHV-6 meningoencephalitis Assessment/

Results: After admission to inpatient rehabilitation hospital four weeks from symptom onset, he continued to experience significant bilateral gaze nystagmus with oscillopsia, and ataxic gait causing whole body tremors, leading to severe and hard to manage dizziness and nausea.

Discussion: HHV-6 is a condition that primarily presents in children with roseola infantum, and in immunocompromised individuals as meningoencephalitis. There are very few cases reported in immunocompetent adults. However, recent studies looking at cases of encephalitis of unknown cause found HHV-6 DNA in the CSF of 6-10% of the cases, indicating a more common prevalence than previously thought. HHV-6 meningoencephalitis has a wide range of reported symptoms, but cerebellar ataxia and nystagmus have only been reported in a few infant cases and none in the adults.

Conclusion: HHV-6 meningoencephalitis is rarely seen in immunocompetent adults and it has a widely varied presentation, so it is important to screen for it in patients presenting with encephalitis. Furthermore, nystagmus and cerebellar ataxia are not common findings in these patients. Given that neurological outcomes can vary from full recovery to death, it is important to perform a thorough workup for patients with this presentation.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/atypical-presentation-of-human-herpesvirus-6-meningoencephalitis-with-cerebellar-ataxia-and-nystagmus-a-case-report/