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Corticosteroid-responsive focal granulomatous herpes simplex type-1 encephalitis in adults

Corticosteroid-responsive focal granulomatous herpes simplex type-1 encephalitis in adults
Corticosteroid-responsive focal granulomatous herpes simplex type-1 encephalitis in adults

We describe corticosteroid-responsive focal granulomatous encephalitis as a manifestation of herpes simplex virus (HSV) type 1 disease in the brain: something easily missed and easily treated. Two adult cases presented with cognitive symptoms progressing over weeks, despite aciclovir treatment. Brain imaging showed temporal lobe abnormalities, with gadolinium enhancement but no abnormal diffusion restriction. HSV-1 PCR analysis was negative in cerebrospinal fluid (CSF) but positive in brain biopsies, which showed vasocentric granulomatous inflammation. Paired blood and CSF samples showed intrathecal synthesis of HSV-1 type-specific IgG. The patients improved clinically only after immunosuppression. Despite profound cognitive impairment at their clinical nadir, both patients recovered fully. We suggest that, at least in a subset of patients with HSV-1 encephalitis, adjunctive corticosteroid treatment is critical to improve the outcome of the disease.

Acyclovir, Adrenal Cortex Hormones, Antiviral Agents, Encephalitis, Herpes Simplex, Female, Herpesvirus 1, Human, Humans, Magnetic Resonance Imaging, Middle Aged, Journal Article
1474-7758
140-144
Varatharaj, Aravinthan
33d833af-9459-4b21-8489-ce9c0b6a09e0
Nicoll, James A.R.
88c0685f-000e-4eb7-8f72-f36b4985e8ed
Pelosi, Emanuela
d07026a0-0508-47d1-92de-b99c22aa29da
Pinto, Ashwin A.
0936a2c0-8634-4aa7-867e-e64566c0c9e2
Varatharaj, Aravinthan
33d833af-9459-4b21-8489-ce9c0b6a09e0
Nicoll, James A.R.
88c0685f-000e-4eb7-8f72-f36b4985e8ed
Pelosi, Emanuela
d07026a0-0508-47d1-92de-b99c22aa29da
Pinto, Ashwin A.
0936a2c0-8634-4aa7-867e-e64566c0c9e2

Varatharaj, Aravinthan, Nicoll, James A.R., Pelosi, Emanuela and Pinto, Ashwin A. (2017) Corticosteroid-responsive focal granulomatous herpes simplex type-1 encephalitis in adults. Practical Neurology, 17 (2), 140-144. (doi:10.1136/practneurol-2016-001474).

Record type: Article

Abstract

We describe corticosteroid-responsive focal granulomatous encephalitis as a manifestation of herpes simplex virus (HSV) type 1 disease in the brain: something easily missed and easily treated. Two adult cases presented with cognitive symptoms progressing over weeks, despite aciclovir treatment. Brain imaging showed temporal lobe abnormalities, with gadolinium enhancement but no abnormal diffusion restriction. HSV-1 PCR analysis was negative in cerebrospinal fluid (CSF) but positive in brain biopsies, which showed vasocentric granulomatous inflammation. Paired blood and CSF samples showed intrathecal synthesis of HSV-1 type-specific IgG. The patients improved clinically only after immunosuppression. Despite profound cognitive impairment at their clinical nadir, both patients recovered fully. We suggest that, at least in a subset of patients with HSV-1 encephalitis, adjunctive corticosteroid treatment is critical to improve the outcome of the disease.

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Varatharaj et al 2017 - Accepted Manuscript
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Accepted/In Press date: 14 December 2016
e-pub ahead of print date: 2 February 2017
Published date: April 2017
Additional Information: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Keywords: Acyclovir, Adrenal Cortex Hormones, Antiviral Agents, Encephalitis, Herpes Simplex, Female, Herpesvirus 1, Human, Humans, Magnetic Resonance Imaging, Middle Aged, Journal Article

Identifiers

Local EPrints ID: 413486
URI: https://eprints.soton.ac.uk/id/eprint/413486
ISSN: 1474-7758
PURE UUID: a2a3ddd2-de80-4d61-91ba-2b0bd86a66cd
ORCID for Aravinthan Varatharaj: ORCID iD orcid.org/0000-0003-1629-5774
ORCID for James A.R. Nicoll: ORCID iD orcid.org/0000-0002-9444-7246

Catalogue record

Date deposited: 24 Aug 2017 16:31
Last modified: 26 Nov 2019 01:50

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