Acute hemorrhagic leukoencephalitis mimicking herpes simplex encephalitis: case report.
Acute hemorrhagic leukoencephalitis (AHLE) is a more severe form of acute disseminated encephalomyelitis (ADEM) characterized by a fulminant clinical course and the presence of hemorrhagic necrosis of the white matter. We report the case of a 57-year-old woman who developed delirium following a respiratory infection. Magnetic resonance imaging of the brain disclosed signal abnormalities in the frontal and temporal lobes, usually found in herpes simplex encephalitis (HSE). Gram stain, India ink and acid-fast bacilli staining were all negative in CSF as was a polymerase chain reaction (PCR) for herpes simplex virus. A diagnosis of AHLE was made and the patient was treated with i.v. methylprednisolone 1g/day for 5 days. Despite treatment, the patient developed several neurological sequelae compatible with the severity of her illness.
Martins
Henrique Milhomem
HM
Minas Gerais Center for Investigation of Multiple Sclerosis, Medical School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
Teixeira
Antônio Lúcio
AL
Lana-Peixoto
Marco Aurélio
MA
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D004684:Leukoencephalitis, Acute Hemorrhagic / Q000175:diagnosis* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone