Chronic granulomatous herpes encephalitis: a rare entity posing a diagnostic challenge

2011 ◽  
Vol 8 (4) ◽  
pp. 402-406 ◽  
Author(s):  
Matthew A. Adamo ◽  
Lisa Abraham ◽  
Ian F. Pollack
Keyword(s):  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Disease Process ◽  
Toll Like Receptor ◽  
Herpes Encephalitis ◽  
Diagnostic Challenge ◽  
Intractable Seizures ◽  
History Of ◽  
Simplex Virus ◽  
Chronic Disease State

Herpesviruses can cause an acute, subacute, or chronic disease state in both immunocompetent and immunocompromised individuals. Herpes simplex virus (HSV) encephalitis is most often an acute monophasic disease process. Rarely, however, it may progress to a chronic state, and more rarely still to a granulomatous encephalitis. Prior studies have suggested that antiviral immunity with Toll-like receptors determines susceptibility to herpesviruses. The authors report the case of a 14-year-old girl with a remote history of treated HSV encephalitis, who had intractable seizures and worsening MR imaging changes that were concerning for either a neoplastic or an inflammatory process. She was found to have granulomatous herpes simplex encephalitis and had a low cytokine response to Toll-like receptor 3 stimulation.

Herpes Simplex Encephalitis Occurring After Chemotherapy, Surgery, and Stereotactic Radiotherapy for Medulloblastoma

2000 ◽  
Vol 124 (12) ◽  
pp. 1809-1812
Author(s):  
S. Molloy ◽  
D. Allcutt ◽  
P. Brennan ◽  
M. A. Farrell ◽  
R. Perryman ◽  
...  
Keyword(s):  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Surgical Removal ◽  
Formalin Fixed Paraffin ◽  
Recurrent Herpes ◽  
Formalin Fixed Paraffin Embedded ◽  
History Of ◽  
Cerebellar Medulloblastoma ◽  
Simplex Virus ◽  
Inflammatory Changes

Abstract Reactivation of latent herpes simplex virus (HSV) in the trigeminal ganglion most commonly gives rise to recurrent herpes labialis and rarely to herpes simplex encephalitis. The mechanisms underlying reactivation of latent trigeminal HSV are complex. Here we report the case history of a 25-year-old woman who developed a fatal, bilateral necrotizing destructive temporal lobe lesion following surgical removal of a cerebellar medulloblastoma and combined radiotherapy and chemotherapy for recurrent tumor. Neuropathologic examination of the brain revealed minimal inflammatory changes, but immunohistochemistry was positive for HSV protein, and HSV deoxyribonucleic acid (DNA) was recovered from formalin-fixed paraffin-embedded brain tissue. The temporal proximity of the surgery, chemotherapy, and radiotherapy to the onset of disease suggests that these factors may have acted as triggers that precipitated conversion of latent HSV to overt HSV.

Herpes encephalitis and hepatitis in pregnancy: A case report and literature review

2020 ◽  
pp. 1753495X2097803
Author(s):  
Claire M McCarthy ◽  
Caroline Conlon ◽  
Maria Kennelly ◽  
Richard Drew ◽  
Stephen Stewart ◽  
...  
Keyword(s):  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Male Infant ◽  
Herpes Encephalitis ◽  
Intravenous Acyclovir ◽  
Simplex Virus ◽  
Herpes Simplex Virus 2 ◽  
Elevated Transaminases ◽  
Work Up ◽  
In Pregnancy

We present the case of a healthy nulliparous woman who presented with persistent fever, proteinuria and elevated transaminases at 33 weeks’ gestation. Following initial treatment for suspected chorioamnionitis and potential pre-eclampsia, she had a caesarean section delivering a healthy male infant. However, on her third post-operative day, she developed neurological symptoms and accompanying severe sepsis, necessitating inotropic support and transfer to a higher level of care. A comprehensive work-up revealed Herpes Simplex Virus-2 (HSV-2) in serum and cerebrospinal fluid. Abdominal imaging was suggestive of accompanying hepatitis with micro-abscesses. This lady recovered well following intravenous acyclovir for 14 days. Her infant was not affected and was discharged home with his mother. Herpes simplex encephalitis and hepatitis associated with HSV-2 have been described three times previously in pregnancy. We delineate the diagnostic challenges that rare conditions such as this pose and emphasise the importance of multi-disciplinary care in managing complicated medical conditions in pregnancy.

scholarly journals Application of Competitive PCR to Cerebrospinal Fluid Samples from Patients with Herpes Simplex Encephalitis

1998 ◽  
Vol 36 (8) ◽  
pp. 2229-2234 ◽  
Author(s):  
R. B. Domingues ◽  
F. D. Lakeman ◽  
M. S. Mayo ◽  
R. J. Whitley
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Internal Standard ◽  
Herpes Encephalitis ◽  
Standard Curve ◽  
Intravenous Acyclovir ◽  
Primer Annealing ◽  
Acyclovir Therapy ◽  
Simplex Virus

The purpose of the present study was to determine if the quantity of herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) of patients with herpes encephalitis would be useful in establishing the prognosis of the disease and to determine the effect of antiviral therapy on the clearance of viral DNA from the CSF. Quantitation of HSV DNA was done by constructing an internal standard (IS) from the glycoprotein B amplicon which had a 25-bp deletion between primer annealing sites. Each CSF specimen was coamplified with the IS and the ratio of the amount of HSV/amount of IS was compared to the ratios on a standard curve constructed with the same IS plus known amounts of HSV DNA. CSF specimens were available from 16 patients who were treated with intravenous acyclovir, and the amount of HSV DNA ranged from <25 to 18,000 copies per μl in CSF obtained before or within 4 days of the initiation of acyclovir therapy. Patients with >100 copies of HSV DNA per μl were older, were found by computed tomography to have lesions, and had poorer outcomes than patients with <100 copies. Follow-up CSF specimens were available from seven patients. In six of these seven patients, the HSV DNA levels decreased during therapy. One patient had a twofold increase in HSV DNA levels after 1 week of therapy and died on day 8. The application of this assay may be helpful in establishing the prognosis and in the monitoring of patients with herpes simplex encephalitis.

Relapse of herpes encephalitis induced by temozolomide-based chemoradiation in a patient with malignant glioma

2013 ◽  
Vol 118 (2) ◽  
pp. 258-263 ◽  
Author(s):  
Masaki Okada ◽  
Keisuke Miyake ◽  
Aya Shinomiya ◽  
Nobuyuki Kawai ◽  
Takashi Tamiya
Keyword(s):  
Herpes Simplex ◽  
Malignant Glioma ◽  
Antiviral Therapy ◽  
Herpes Simplex Encephalitis ◽  
Viral Reactivation ◽  
Herpes Encephalitis ◽  
Antitumor Therapy ◽  
Careful Observation ◽  
History Of

The authors report on a case of concurrent herpes simplex encephalitis (HSE) and malignant glioma. The co-occurrence of HSE and malignant glioma is very rare, but it can occur during glioma treatment. Both radiotherapy and chemoradiation with temozolomide can induce viral reactivation, leading to HSE relapse. Careful observation for HSE is necessary when administering chemoradiation to patients with a history of HSE. Antiviral therapy for HSE must be initiated immediately, and the chemoradiation for glioma should be stopped; however, it is not clear what antitumor therapy is optimal when HSE co-occurs during the treatment of glioma.

scholarly journals Functional IRF3 deficiency in a patient with herpes simplex encephalitis

2015 ◽  
Vol 212 (9) ◽  
pp. 1371-1379 ◽  
Author(s):  
Line Lykke Andersen ◽  
Nanna Mørk ◽  
Line S. Reinert ◽  
Emil Kofod-Olsen ◽  
Ryo Narita ◽  
...  
Keyword(s):  
Herpes Simplex ◽  
Autosomal Dominant ◽  
Viral Infections ◽  
Herpes Simplex Encephalitis ◽  
Type I ◽  
Toll Like Receptor ◽  
Loss Of Function ◽  
Impaired Ability ◽  
Increased Susceptibility ◽  
Hsv 1

Herpes simplex encephalitis (HSE) in children has previously been linked to defects in type I interferon (IFN) production downstream of Toll-like receptor 3. Here, we describe a novel genetic etiology of HSE by identifying a heterozygous loss-of-function mutation in the IFN regulatory factor 3 (IRF3) gene, leading to autosomal dominant (AD) IRF3 deficiency by haploinsufficiency, in an adolescent female patient with HSE. IRF3 is activated by most pattern recognition receptors recognizing viral infections and plays an essential role in induction of type I IFN. The identified IRF3 R285Q amino acid substitution results in impaired IFN responses to HSV-1 infection and particularly impairs signaling through the TLR3–TRIF pathway. In addition, the R285Q mutant of IRF3 fails to become phosphorylated at S386 and undergo dimerization, and thus has impaired ability to activate transcription. Finally, transduction with WT IRF3 rescues the ability of patient fibroblasts to express IFN in response to HSV-1 infection. The identification of IRF3 deficiency in HSE provides the first description of a defect in an IFN-regulating transcription factor conferring increased susceptibility to a viral infection in the CNS in humans.

Asymptomatic shedding of herpes simplex virus from the genital tract: uncertainty and its consequences for patient management

1996 ◽  
Vol 7 (4) ◽  
pp. 229-232 ◽  
Author(s):  
S E Barton ◽  
P E Munday ◽  
R J Patel
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Genital Herpes ◽  
Genital Tract ◽  
Patient Management ◽  
Sexual Transmission ◽  
Supportive Counselling ◽  
History Of ◽  
Simplex Virus ◽  
The Relationship

A frequent component of the management of patients with genital herpes concerns the possibility of asymptomatic shedding and potential sexual transmission of the virus. Approaches intended to provide supportive counselling and reassurance of patients about these issues need now to be modified in the light of increasing data of the frequency of asymptomatic detection of virus and the effects of antiviral therapy on this phenomenon. Further studies to delineate the relationship between asymptomatic detection of HSV in the genital tract and the mechanism of sexual transmission of this virus need to be conducted before clinicians instigate antiviral suppressive treatment primarily to prevent sexual transmission of HSV. However, it is important that the new data and our greater understanding of the natural history of genital herpes is translated into accurate and comprehensible information for our patients.

Herpes Simplex Virus Infections

1996 ◽  
Vol 17 (12) ◽  
pp. 415-423
Author(s):  
Paula W. Annunziato
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Hepatitis B Surface Antigen ◽  
Liver Function Tests ◽  
Virus Infections ◽  
Sexually Transmitted ◽  
The Third ◽  
Intravenous Acyclovir ◽  
History Of ◽  
Simplex Virus

Case Report A term female developed fever and tachypnea and had a transient episode of poor color and tone on the third day of life. She was delivered by cesarean section 5 hours after rupture of membranes to a 19-year-old, gravida 4, para 0 mother whose serology was negative for syphilis, human immunodeficiency virus (HIV), and hepatitis B surface antigen. The mother had no history of sexually transmitted diseases. Apgar scores were 8 at 1 minute and 9 at 10 minutes. When the infant was admitted to the nursery, scalp abrasions were noticed by the nurse. On the third day of life, a sepsis evaluation was initiated, and the infant received ampicillin and gentamicin intravenously: no bacterial infection was found. On the fifth day of life, vesicular lesions were noticed on her scalp. Bilateral interstitial infiltrates were present On chest radiograph and laboratory studies revealed mild elevations in liver function tests. There were no cerebrospinal fluid (CSF) abnormalities. She was started on intravenous acyclovir, and herpes simplex virus (HSV)-2 subsequently was isolated from both her pharynx and scalp lesions. After receiving intravenous acyclovir for 3 weeks, she was discharged with no evidence of residual sequelae. Four days after acyclovir was discontinued, new scalp vesicles appeared and the infant developed a temperature of 38.8°C (102°F).

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