HSV encephalitis in a child with brain stem glioma: a rare complication of therapy. Case report and review of the neurosurgical literature.
BACKGROUND
Herpes simplex virus (HSV) encephalitis is a rare association with pediatric neurosurgical pathologies.


METHODS
A 13-year-old boy was diagnosed with an inoperable, biopsy-proven pontine grade II astrocytoma. During radiotherapy, he developed status epilepticus controlled by thiopentone with intubation and ventilation. Empiric cefotaxime and aciclovir were given. Lumbar cerebrospinal fluid (CSF) showed a normal white cell count, normal glucose, and a slightly elevated protein level. However, the CSF showed a positive polymerase chain reaction (PCR) for HSV type 1 DNA. Intravenous aciclovir was given for 21 days and foscarnet for 7 days. He was extubated after 4 weeks at which time he was aphasic with spastic diplegia. After 8 weeks, MRI brain scan showed the typical bitemporal pattern of HSV encephalitis. He made slow improvement but died 8 months after diagnosis from tumor progression.


CONCLUSIONS
HSV encephalitis is a rare but life threatening complication in neurosurgical patients. A low threshold for both investigation with CSF PCR and empirical treatment with intravenous aciclovir is warranted. As in this case, initial microscopic examination of the CSF may be normal. The literature on HSV encephalitis in neurosurgical patients is discussed.
Spacca
Barbara
B
Department of Neurosurgery, Royal Liverpool Children's Hospital NHS Trust, Liverpool, UK.
Mallucci
Conor
C
Riordan
Andrew
A
Appleton
Richard
R
Thorp
Nicky
N
Pizer
Barry
B
D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D001254:Astrocytoma / Q000150:complications* / Q000532:radiotherapy; D020295:Brain Stem Neoplasms / Q000150:complications* / Q000532:radiotherapy; D020803:Encephalitis, Herpes Simplex / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000209:etiology*; D017809:Fatal Outcome; D018259:Herpesvirus 1, Human; D006801:Humans; D008297:Male; D011878:Radiotherapy / Q000009:adverse effects*
D000998:Antiviral Agents; D000212:Acyclovir