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Relapsing herpes simplex encephalitis: pathological confirmation of viral reactivation
  1. S Yamada1,
  2. T Kameyama1,
  3. S Nagaya2,
  4. Y Hashizume3,
  5. M Yoshida3
  1. 1Department of Neurology, Gifu Prefectural Tajimi Hospital, Gifu, Japan
  2. 2Second Department of Pathology, Nagoya City University, Aichi, Japan
  3. 3Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan
  1. Correspondence to:
    Dr Shin-ichi Yamada, Department of Neurology, Nakatsugawa Municipal General Hospital, 1522-1, Komanba, Nakatsugawa, Gifu, Japan 508-8502;


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.

  • encephalitis
  • herpes simplex virus

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