title: Acute hemorrhagic leukoencephalitis mimicking herpes simplex encephalitis: case report.
abstract: 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.
authors.affiliation: Minas Gerais Center for Investigation of Multiple Sclerosis, Medical School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Henrique Milhomem
authors.initials: HM
authors.lastname: Martins
authors.forename: Antônio Lúcio
authors.initials: AL
authors.lastname: Teixeira
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Lana-Peixoto
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone