Acute Presentation of Newly Diagnosed Multiple Sclerosis Associated With Polymerase Chain Reaction-Proven Human Herpesvirus 6 Central Nervous System Infection

Abstract

We present the case of a 26-year-old male who was found to have human herpesvirus 6 (HHV-6) in his cerebrospinal fluid (CSF) during acute presentation of multiple sclerosis (MS). Paresthesia of the lower extremities was his only symptom during the initial presentation, and workup for MS was not included during this evaluation. A single dose of IV steroids failed to improve his condition, and symptoms became more severe. Upon secondary evaluation, MRI revealed white-matter disease with plaques at multiple levels of the cervical spine and central nervous system (CNS). Lumbar puncture was obtained, and CSF analysis was positive for HHV-6 DNA. After five days of oral steroid treatment and physical therapy for three weeks, his symptoms continued to worsen. MRI at this time demonstrated an increase in the size of previous plaques and new foci of white matter disease. Repeat CSF analysis was negative for HHV-6. The virus' association with relapse of MS has been investigated by many studies. However, there is a lack of literature investigating its role in causing MS disease. In this case report, we highlight the need for further research aimed at determining if HHV-6 is an environmental trigger for MS disease onset.