Zapalenie mózgu вызванное wirusem ospy człowieka typ 7 u dorosłego z prawidłowym układem odpornościowym powikłane wielonarządowym uszkodzeniem i przewlekłą opornąc na leczenie epilepsją: unikalny przypadek wymagający wsparcia VA-ECMO i przegląd systematyczny przypadków u dorosłych

Abstract Background: Human herpesvirus 7 ( HHV -7) is a ubiquitous latent virus predominantly causing benign infantile exanthema subitum, while severe HHV -7 encephalitis in immunocompetent adults is extremely rare, with fewer than 20 global case reports to date. To date, fewer than 20 immunocompetent adult HHV -7 encephalitis cases have been recorded globally, and none reported in Virology Journal or other peer-reviewed journals present concurrent fulminant rhabdomyolysis, acute kidney injury (AKI), consumptioncoagulopathy and post-extracorporeal membrane oxygenation (ECMO) refractory epilepsy. Rhabdomyolysis is a lethal complication frequently induced by prolonged status epilepticus. To our knowledge, no prior literature has documented an immunocompetent adult with HHV -7 encephalitis complicated simultaneously by fulminant rhabdomyolysis,myoglobin-mediated AKI, VA-ECMO-dependent refractory cardiorespiratory failure, andpersistent refractory epilepsy after extracorporeal support weaning. The pathogenesis and long-term prognosis of this unique critical phenotype remain poorly characterized [16]. Case presentation : A 35-year-old immunocompetent male without underlying immune disorders was admitted with sustained fever, recurrent generalized tonic-clonic seizures, altered mental status, severe limb myalgia and oliguria. Laboratory tests revealed markedly elevated creatine kinase (CK) and myoglobin, oliguric AKI and consumptivecoagulopathy [10]. Cranial magnetic resonance imaging (MRI) displayed symmetric bilateral cortical and thalamic inflammatory lesions distinct from focal lesions in the mild HHV -7 case previously published in Virology Journal, and cerebrospinal fluid metagenomic next-generation sequencing (mNGS) confirmed exclusive high-load HHV -7 infection without mixed pathogens [5]. The patient progressed to combined refractory cardiacand respiratory shock and received 5 days of VA-ECMO support following Extracorporeal Life Support Organization (ELSO) guidelines [1,2]. After comprehensive antiviral, organ replacement and neuroprotective treatment, systemic organ function fully recoveredand ECMO was successfully withdrawn. However, recurrent seizures with diffuseepileptiform discharges on serial electroencephalography (EEG) persisted long after viral clearance [11]. Conclusions: Compared with previously reported mild immunocompetent adult HHV -7 encephalitis cases, our patient exhibited unprecedented life-threatening multisystem complications and persistent post-infection epilepsy despite complete viral clearance. Severe HHV -7 encephalitis can rapidly trigger fatal multi-organ injury dominated by fulminantrhabdomyolysis and AKI [8]. VA-ECMO acts as a transient salvage measure for irreversible dual cardiorespiratory failure, yet it cannot prevent permanent central nervous system lesions and subsequent intractable epilepsy [3]. Long-term EEG surveillance and individualized antiepileptic therapy based on International League Against Epilepsy (ILAE) criteria are required to optimize neurological prognosis for this rare viral encephalopathy subtype [14].