Severe Presentation of Antibody-negative, Postinfectious Steroid-responsive Encephalitis and Atonic Bladder After Herpes Simplex Encephalitis

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2019 Jul 25

PMID 31337628

Citations 1

Authors

Luay Mrad

Argirios Moustakas

Robert Fuino

Waqar Waheed

Affiliations

Soon will be listed here.

Abstract

A 75-year-old woman presented with new onset of confusion, intense episodic dizziness and formed visual hallucinations. Herpes simplex encephalitis and non-convulsive temporal lobe seizures were confirmed with cerebrospinal fluid (CSF) and electroencephalography testing. In addition, her hospital course was complicated by syndrome of inappropriate antidiuretic hormone secretion and atonic bladder contributing to an episode of urinary tract infection. After completing 3 weeks of acyclovir treatment, the patient became obtunded with right arm choreiform movements and persistent inflammatory CSF findings not attributable to persistent herpes simplex virus infection or other confounding factors. The patient responded to steroid treatment. Repeated autoimmune and paraneoplastic evaluations were negative. Both clinical (cognitive testing and atonic bladder) and CSF inflammatory finding improved in the follow-up period.

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References

Sauerbrei A . Acyclovir resistance in herpes simplex virus type I encephalitis: a case report. J Neurovirol. 2017; 23(4):638-639. DOI: 10.1007/s13365-017-0537-9. View

Wildemann B, Ehrhart K, Storch-Hagenlocher B, Meyding-Lamade U, Steinvorth S, Hacke W . Quantitation of herpes simplex virus type 1 DNA in cells of cerebrospinal fluid of patients with herpes simplex virus encephalitis. Neurology. 1997; 48(5):1341-6. DOI: 10.1212/wnl.48.5.1341. View

Kusuhara T, Nakajima M, Inoue H, Takahashi M, Yamada T . Parainfectious encephalomyeloradiculitis associated with herpes simplex virus 1 DNA in cerebrospinal fluid. Clin Infect Dis. 2002; 34(9):1199-205. DOI: 10.1086/339811. View

Meyding-Lamade U, Oberlinner C, Rau P, Seyfer S, Heiland S, Sellner J . Experimental herpes simplex virus encephalitis: a combination therapy of acyclovir and glucocorticoids reduces long-term magnetic resonance imaging abnormalities. J Neurovirol. 2003; 9(1):118-25. DOI: 10.1080/13550280390173373. View

Hatipoglu H, Sakman B, Yuksel E . Magnetic resonance and diffusion-weighted imaging findings of herpes simplex encephalitis. Herpes. 2008; 15(1):13-7. View

Naito K, Hashimoto T, Ikeda S . Herpes simplex virus type-1 meningoencephalitis showing disseminated cortical lesions. Intern Med. 2007; 46(11):761-3. DOI: 10.2169/internalmedicine.46.6276. View

Stranska R, Schuurman R, Nienhuis E, Goedegebuure I, Polman M, Weel J . Survey of acyclovir-resistant herpes simplex virus in the Netherlands: prevalence and characterization. J Clin Virol. 2004; 32(1):7-18. DOI: 10.1016/j.jcv.2004.04.002. View

Piret J, Boivin G . Innate immune response during herpes simplex virus encephalitis and development of immunomodulatory strategies. Rev Med Virol. 2015; 25(5):300-19. DOI: 10.1002/rmv.1848. View

Bien C, Benninger F, Urbach H, Schramm J, Kurthen M, Elger C . Localizing value of epileptic visual auras. Brain. 2000; 123 ( Pt 2):244-53. DOI: 10.1093/brain/123.2.244. View

10.

Andrei G, Snoeck R . Herpes simplex virus drug-resistance: new mutations and insights. Curr Opin Infect Dis. 2013; 26(6):551-60. DOI: 10.1097/QCO.0000000000000015. View

11.

Joshi P . Multiple strokes associated with herpes simplex virus type-2 infection: case report. J Neurovirol. 2015; 22(2):251-3. DOI: 10.1007/s13365-015-0385-4. View

12.

Menasria R, Canivet C, Piret J, Boivin G . Infiltration Pattern of Blood Monocytes into the Central Nervous System during Experimental Herpes Simplex Virus Encephalitis. PLoS One. 2015; 10(12):e0145773. PMC: 4689369. DOI: 10.1371/journal.pone.0145773. View

13.

Tarnutzer A, Lee S, Robinson K, Kaplan P, Newman-Toker D . Clinical and electrographic findings in epileptic vertigo and dizziness: a systematic review. Neurology. 2015; 84(15):1595-604. PMC: 4408281. DOI: 10.1212/WNL.0000000000001474. View

14.

Hewett R, Guye M, Gavaret M, Bartolomei F . Benign temporo-parieto-occipital junction epilepsy with vestibular disturbance: an underrecognized form of epilepsy?. Epilepsy Behav. 2011; 21(4):412-6. DOI: 10.1016/j.yebeh.2011.05.017. View

15.

Martinez-Torres F, Menon S, Pritsch M, Victor N, Jenetzky E, Jensen K . Protocol for German trial of Acyclovir and corticosteroids in Herpes-simplex-virus-encephalitis (GACHE): a multicenter, multinational, randomized, double-blind, placebo-controlled German, Austrian and Dutch trial [ISRCTN45122933]. BMC Neurol. 2008; 8:40. PMC: 2605746. DOI: 10.1186/1471-2377-8-40. View

16.

Hellden A, Lycke J, Vander T, Svensson J, Odar-Cederlof I, Stahle L . The aciclovir metabolite CMMG is detectable in the CSF of subjects with neuropsychiatric symptoms during aciclovir and valaciclovir treatment. J Antimicrob Chemother. 2006; 57(5):945-9. DOI: 10.1093/jac/dkl067. View

17.

Thind G, Roach R . A case of acyclovir neurotoxicity presenting with atypical cerebrospinal fluid findings. BMJ Case Rep. 2017; 2017. PMC: 5753732. DOI: 10.1136/bcr-2017-220372. View

18.

De Tiege X, Rozenberg F, Portes V, Lobut J, Lebon P, Ponsot G . Herpes simplex encephalitis relapses in children: differentiation of two neurologic entities. Neurology. 2003; 61(2):241-3. DOI: 10.1212/01.wnl.0000073985.71759.7c. View

19.

Ramos-Estebanez C, Lizarraga K, Merenda A . A systematic review on the role of adjunctive corticosteroids in herpes simplex virus encephalitis: is timing critical for safety and efficacy?. Antivir Ther. 2013; 19(2):133-9. DOI: 10.3851/IMP2683. View

20.

George B, Schneider E, Venkatesan A . Encephalitis hospitalization rates and inpatient mortality in the United States, 2000-2010. PLoS One. 2014; 9(9):e104169. PMC: 4156306. DOI: 10.1371/journal.pone.0104169. View