Fatal primary infection due to human herpesvirus 6 variant A in a renal transplant recipient

We describe a fatal primary human herpesvirus 6 (HHV-6) variant A infection in a kidney transplanted adult woman. On day 20 post transplantation (TX), after rejection therapy; the patient presented an acute hemophagocytic syn drome with hepatitis and central nervous system involvement. HHV-6 IgG and IgM antibodies seroconversion was demonstrated. HHV-6 variant A was the sol e pathogen detected by nested PCR and/or culture in blood, bone marrow aspi ration, liver biopsy, cerebrospinal fluid and bronchoalveolar lavage. The g raft was HHV-6 seropositive and the patient was not transfused before day 2 8 post TX, suggesting that the virus was transmitted by the graft Despite i mmunoglobulins, ganciclovir and foscarnet therapy, the HHV-6 infection prog ressed and led to severe aplasia. The patient developed Aspergillus fumigat us pneumonia and died from fulminant candidemia. This case demonstrated for the first time that HHV-6 variant A primary infection can cause life-threa tening disseminated infection in immunosuppressed patients.