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Short report
Herpes simplex encephalitis in glioma patients: a challenging diagnosis
  1. Giulia Berzero1,2,
  2. Anna Luisa Di Stefano1,3,
  3. Caroline Dehais3,
  4. Marc Sanson3,
  5. Paola Gaviani4,
  6. Antonio Silvani4,
  7. Andrea Salmaggi4,5,
  8. Paolo Vitali1,
  9. Luca Diamanti1,2,
  10. Fausto Baldanti6,
  11. Lisa Maria Farina1,
  12. Mauro Ceroni1,7,
  13. Enrico Marchioni1
  1. 1C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy
  2. 2Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Pavia, Italy
  3. 3AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris, France
  4. 4Neuro-oncology Unit, C. Besta Neurological Institute, Milan, Italy
  5. 5SC Neurologia, Ospedale A. Manzoni, Lecco, Italy
  6. 6Molecular Virology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  7. 7Department of Neuroscience, University of Pavia, Pavia, Italy
  1. Correspondence to Dr E Marchioni, C. Mondino Foundation, Via Mondino 2, Pavia 27100, Italy; enrico.marchioni{at}


Objectives In recent years, herpes simplex encephalitis (HSE) has been reported with increasing frequency in settings of immunosuppression, such as acquired immunodeficiency, transplantation and cancer. As observed, in immunocompromised individuals HSE presents peculiar clinical and paraclinical features, and poorer prognosis.

Methods Here we describe a retrospective series of seven cases of HSE in patients with high-grade glioma (HGG), collected among three institutions in a 5-year period (during this time, a total of 1750 patients with HGG were treated).

Results Diagnosis of the condition was particularly challenging due to the confounding clinical presentation and the atypical biological findings. As a result, antiviral treatment was started with a sharp delay compared with immunocompetent hosts. Prognosis was poor, with high short-term mortality and severe residual disability in survivors.

Conclusions The substantial incidence of HSE observed in our centres together with the difficulty in diagnosing the condition suggest that the incidence of this complication may be highly underestimated. The aim of our report is to strengthen the observation of HSE in patients with HGG and outline the key elements that may allow its diagnosis.

  • Clinical Neurology
  • Infectious Diseases
  • Neurooncology
  • Neurovirology
  • Radiotherapy

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