Brain stem encephalitis caused by primary herpes simplex 2 infection in a young woman. Issue 9 (21st August 2003)

• Record Type: Journal Article
• Authors: Tang, J W; Coward, L J; Davies, N W S; Geretti, A M; Howard, R S; Hirsch, N P; Ward, K N
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 74:Issue 9(2003)
• Page Start: 1323
• Page End: 1325
• Publication Date: 2003-08-21
• Subjects: brain stem encephalitis -- herpesvirus 2 -- acyclovir; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp.74.9.1323
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : A 27 year old woman developed a vesicular genital rash and cerebellar dysfunction with progressive neurological deterioration suggesting brain stem encephalitis. Respiratory support was required. Magnetic resonance imaging (MRI) of the brain on day 7 showed signal hyperintensity in the central medulla and ventral pons, typical of acute inflammation. The course was severe and relapse occurred. MRI on day 33 showed a haemorrhagic area in the medulla. Treatment with aciclovir/valaciclovir eventually led to gradual recovery. Herpes simplex virus 2 (HSV-2) DNA was detected in CSF on days 11 and 14. HSV-2 was also detected in vesicle fluid from the genital rash. Serum was initially negative for HSV-1 and HSV-2 antibodies, but convalescent samples showed seroconversion to HSV-2, indicating primary infection. Intrathecal synthesis of oligoclonal IgG bands specific for HSV was identified in the CSF. It is important to differentiate HSV-2 from HSV-1, and primary from initial or reactivated infection, so that prolonged aciclovir treatment followed by prophylaxis is instituted to prevent the high likelihood of symptomatic relapse in primary HSV-2 infection.