Relapsing herpes simplex encephalitis: pathological confirmation of viral reactivation.
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.
Yamada
S
S
Department of Neurology, Gifu Prefectural Tajimi Hospital, Gifu, Japan. y.shinichi@nifty.com
Kameyama
T
T
Nagaya
S
S
Hashizume
Y
Y
Yoshida
M
M
D001284:Atrophy; D002540:Cerebral Cortex / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D020803:Encephalitis, Herpes Simplex / Q000473:pathology* / Q000821:virology; D006801:Humans; D007181:Inclusion Bodies, Viral / Q000000981:diagnostic imaging; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D009457:Neuroglia / Q000473:pathology / Q000821:virology; D009474:Neurons / Q000473:pathology / Q000821:virology; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014775:Virus Activation / Q000502:physiology*
D004279:DNA, Viral