SHORT REPORT

Relapsing herpes simplex encephalitis: pathological confirmation of viral reactivation

S Yamada¹, T Kameyama¹, S Nagaya², Y Hashizume³, M Yoshida³

¹ Department of Neurology, Gifu Prefectural Tajimi Hospital, Gifu, Japan
² Second Department of Pathology, Nagoya City University, Aichi, Japan
³ Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan

Correspondence to:
Correspondence to:
Dr Shin-ichi Yamada, Department of Neurology, Nakatsugawa Municipal General Hospital, 1522-1, Komanba, Nakatsugawa, Gifu, Japan 508-8502;
y.shinichi{at}nifty.com

This case is reported to raise awareness of herpes simplex encephalitis as a persisting brain disorder. A 66 year old immunocompetent man developed status epilepticus and died of pneumonia in the course of progressive hemiparesis, cognitive decline, and atrophy of the brain over a five year period after herpes simplex encephalitis. In addition to a completely destroyed left temporal lobe, necropsy revealed active encephalitis consisting of necrosis and lymphocyte infiltration with a large number of intranuclear inclusions in the neurones and glial cells in the markedly oedematous parenchyma of the right frontal and parietal lobes. Herpes simplex virus type 1 (HSV-1) antigen was detected by immunohistochemistry, HSV-1 DNA by in situ hybridisation, and herpes simplex virus nucleocapsids by electronmicroscopy. These clinical and pathological findings suggest that direct viral reactivation might result in a relapse of herpes simplex encephalitis, causing progressive clinical deterioration associated with the persistence of HSV-1 in the brain. This is the first case report demonstrating HSV-1 antigen, HSV-1 DNA, and herpes simplex virus nucleocapsids in a case of relapsing herpes simplex encephalitis.

Keywords: encephalitis; herpes simplex virus

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