[A 61-year-old female who suffered from herpes simplex encephalitis with expanded cerebral lesions on MRI and prolonged clinical course--the diagnostic usefulness of PCR using biopsied brain tissue specimens].
A 61-year-old female developed left hemiparesis after the onset of high fever and a consciousness disturbance. Fluid attenuated inversion recovery (FLAIR) MR imaging showed high signal intensity lesions in the right temporal lobe, cingulate gyrus, and parietal lobe. Encephalitis caused by a herpes simplex virus (HSV) infection was suspected and the administration of intravenous aciclovir was thus immediately initiated. Her consciousness disturbance rapidly became exacerbated; however, the brain lesions progressively expanded to the midbrain and left hemisphere. The addition of intravenous high-dose corticosteroids to the treatment regimen ameliorated the consciousness disturbance. Although no HSV DNA was detected by repeated PCR using cerebrospinal fluid (CSF) specimens, real time PCR using a biopsied brain tissue specimens detected HSV type 1 DNA. A pathological examination showed destruction of the grey matter and a perivascular aggregation of lymphocytes, thus suggesting a diagnosis of necrotizing viral encephalitis. Immunohistochemical analysis did not reveal the presence of the HSV antigen. Hence, in the present patient failure of PCR or a serological diagnosis using CSF specimens can be ascribed to the paucity of viral particles in the brain. We therefore concluded that real-time PCR using biopsied brain tissue specimens is a novel, sensitive method for detecting causative agents in patient with prolonged and undiagnosed encephalitis.
Shimizu
Fumitaka
F
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube-city, Yamaguchi 755-8505, Japan.
Ogasawara
Jun-ichi
J
Koga
Michiaki
M
Kimura
Hiroyo
H
Kawai
Motoharu
M
Negoro
Kiyoshi
K
Kanda
Takashi
T
D000212:Acyclovir / Q000008:administration & dosage; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D001921:Brain / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D018139:Simplexvirus / Q000235:genetics
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D004279:DNA, Viral; D000212:Acyclovir