Pacheco RDO, Rosas FP, Gómez EA, Flores REM

Language: Spanish
References: 7
Page: 35-38
PDF size: 140.99 Kb.

ABSTRACT

Introduction. Relapse after Herpes simplex encephalitis (HSE) occurs in 12-26%, it is related to antiviral treatment in dose low and less than 14 days’ duration. A case of relapse after optimal antiviral treatment is reported.
Description. a three years old female presented with seven days fever, vomiting, behavioral changes and focal seizures, later generalized and recurrent. She had to be admitted into the Intensive Care Unit (ICU). The CSF study showed mononuclear pleocytosis of 197 WBCS/µL; proteins in 38 mg/dL and glucose of 38 mg/dL, the CSF culture and latex agglutination test were negative. PCR test was positive for VHS in CSF and IgM antibodies (+) in serum. The MRI and EEG showed localized right temporal abnormalities. Acyclovir was initiated to 60 mg/kg per day IV for 21 days and she was discharged. Thirty days later she presented again behavioral changes without fever. The CSF had 10 WBCS/µL, positive IgG-VHS antibodies but negative VHS-PCR; both serum IgG and IgM antibodies were positive to VHS. In the MRI, an increased enhancement was observed in whole right brain hemisphere and white matter of left frontal lobe with right brain atrophy. The EEG showed an increased focal abnormality, asymmetric and delta activity. Immunoglobulin serum levels were normal. Acyclovir was restarted to 60 mg/kg per day, prednisone 2 mg/kg per day for 14 days and IGIV 400mg/kg per day for 5 days. After treatment the high signal intensity observed in MRI disappeared.
Discussion. at least two different mechanisms have been related with relapse after HSE: 1) viral replication restarting; or 2) a post-infectious immuno-inflammatory process. Due to the difficulty to identify in some cases, like this one, the implied mechanism, we decided to offer a treatment for the two options with the purpose of improving the prognosis of the patient.

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