title: Chorea as a presentation of herpes simplex encephalitis relapse.
abstract: Three infants, ages 3 months to 3 years, presented with chorea as the initial manifestation of herpes simplex encephalitis (HSE) relapse. Patient 2, treated with repeated 10 day courses of 30 mg/kg/day of acyclovir, had no clear improvement in neurological status. Patient 1, treated with a repeated 10-day course, improved only to have another HSE relapse 4 years later. Patient 3 clearly improved soon after a 3-week course of acyclovir at conventional dosages. A fourth patient (Patient 4) who relapsed with chorea after what was thought to be HSE, and who did not respond to repeated acyclovir treatment, was negative for herpes simplex virus indicators on brain biopsy and DNA testing. We recommend treating all patients suffering from HSE with a minimum 3-week course of acyclovir at 30-35 mg/kg/day in 3 divided doses.
authors.affiliation: Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
authors.forename: G G
authors.initials: GG
authors.lastname: Gascon
authors.forename: A A
authors.initials: AA
authors.lastname: al-Jarallah
authors.forename: E
authors.initials: E
authors.lastname: Okamoto
authors.forename: M
authors.initials: M
authors.lastname: al Ahdal
authors.forename: G
authors.initials: G
authors.lastname: Kessie
authors.forename: H
authors.initials: H
authors.lastname: Frayha
mesh_terms: D001921:Brain / Q000382:microbiology; D002675:Child, Preschool; D002819:Chorea / Q000175:diagnosis*; D004279:DNA, Viral / Q000134:cerebrospinal fluid / Q000302:isolation & purification; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006561:Herpes Simplex / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D012008:Recurrence; D018139:Simplexvirus / Q000302:isolation & purification*; D013997:Time Factors
chemical_list: D004279:DNA, Viral