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Brain stem encephalitis caused by primary herpes simplex 2 infection in a young woman

¹ Department of Virology, Royal Free and University College Medical School, Cleveland Street, London W1, UK
² Harris Neuromedical Intensive Care Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1
³ Neurosciences, Guy’s, King’s, St Thomas’ School of Medicine, Guy’s Hospital Campus, London SE1
⁴ Department of Infection and Public Health Laboratory, King’s College Hospital (Dulwich), East Dulwich Grove, London SE22

Correspondence to:
Correspondence to:
Dr K N Ward, Department of Virology, Royal Free and University College Medical School, Windeyer Institute of Medical Sciences, 46 Cleveland Street, London W1T 4JF;
k.n.ward{at}ucl.ac.uk

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.

Keywords: brain stem encephalitis; herpesvirus 2; acyclovir

This article has been cited by other articles:

				G. Pelligra, N. Lynch, S. P. Miller, M. A. Sargent, and H. Osiovich Brainstem Involvement in Neonatal Herpes Simplex Virus Type 2 Encephalitis Pediatrics, August 1, 2007; 120(2): e442 - e446. [Abstract] [Full Text] [PDF]