{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T03:37:51Z","timestamp":1768275471122,"version":"3.49.0"},"reference-count":42,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2004,5,20]],"date-time":"2004-05-20T00:00:00Z","timestamp":1085011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2004,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We report an adult autologous stem cell transplant (ASCT) patient who developed transplant\u2010associated thrombotic microangiopathy (TMA) due to human herpesvirus\u20106 (HHV\u20106) reactivation. A 58\u2010year\u2010old female with Stage IIIA IgG\u03ba multiple myeloma received a melphalan (200 mg\/m<jats:sup>2<\/jats:sup>) ASCT with discharge home after resolution of ASCT\u2010related toxicities. She presented on D+20 with dyspnea, rash, and fever to 105\u00b0F, followed by worsening dyspnea, hypotension, and capillary leak. Mental status (MS) changes were noted on D+23, but head CT and EEG were unremarkable. On D+29, a generalized seizure occurred with decline in platelet count and haptoglobin. TMA was noted on peripheral blood smear and therapeutic plasma exchange (TPE) was initiated on D+31. Lumbar puncture (LP) revealed CSF protein 74 mg\/dL and white blood count 7,000\/mm<jats:sup>3<\/jats:sup> with 74% lymphocytosis. TPE was continued without improvement in her MS or thrombocytopenia despite improvement in microangiopathy. An MRI of the brain showed a left hippocampus abnormality, and an EEG was consistent with encephalopathy. Serum polymerase chain regimen (PCR) was negative for CMV, HSV1, and HSV2 but was strongly positive for HHV\u20106. Repeat LP protein was 597 mg\/dL. Foscarnet was initiated, and cerebrospinal fluid (CSF) PCR for HHV\u20106 revealed 1,400 DNA copies\/mL. Her MS greatly improved within 48 hr of antiviral therapy, serum HHV\u20106 became negative, and TPE was tapered without recurrence of her TMA. TMA with HHV\u20106 reactivation is likely an underdiagnosed entity. Given its fulminant course and favorable response to therapy, HHV\u20106 reactivation should be considered a potential etiology in patients with TMA after ASCT. Am. J. Hematol. 76:156\u2013162, 2004. \u00a9 2004 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ajh.20068","type":"journal-article","created":{"date-parts":[[2004,5,20]],"date-time":"2004-05-20T22:04:11Z","timestamp":1085090651000},"page":"156-162","source":"Crossref","is-referenced-by-count":24,"title":["Thrombotic microangiopathy (TMA) and stroke due to human herpesvirus\u20106 (HHV\u20106) reactivation in an adult receiving high\u2010dose melphalan with autologous peripheral stem cell transplantation"],"prefix":"10.1002","volume":"76","author":[{"given":"Amy","family":"Belford","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Otha","family":"Myles","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Magill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rick C.","family":"Myhand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie K.","family":"Waselenko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2004,5,20]]},"reference":[{"key":"e_1_2_1_2_2","first-page":"897","article-title":"Hemolytic uremic syndrome after 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