title: Chronic granulomatous herpes encephalitis: a rare entity posing a diagnostic challenge.
abstract: Herpesviruses can cause an acute, subacute, or chronic disease state in both immunocompetent and immunocompromised individuals. Herpes simplex virus (HSV) encephalitis is most often an acute monophasic disease process. Rarely, however, it may progress to a chronic state, and more rarely still to a granulomatous encephalitis. Prior studies have suggested that antiviral immunity with Toll-like receptors determines susceptibility to herpesviruses. The authors report the case of a 14-year-old girl with a remote history of treated HSV encephalitis, who had intractable seizures and worsening MR imaging changes that were concerning for either a neoplastic or an inflammatory process. She was found to have granulomatous herpes simplex encephalitis and had a low cytokine response to Toll-like receptor 3 stimulation.
authors.affiliation: Division of Neurosurgery, Albany Medical Center, Albany, New York, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Adamo
authors.forename: Lisa
authors.initials: L
authors.lastname: Abraham
authors.forename: Ian F
authors.initials: IF
authors.lastname: Pollack
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000175:diagnosis*; D003287:Contrast Media; D016207:Cytokines / Q000378:metabolism; D020278:Demyelinating Autoimmune Diseases, CNS / Q000175:diagnosis*; D003937:Diagnosis, Differential; D020803:Encephalitis, Herpes Simplex / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006099:Granuloma; D006801:Humans; D008279:Magnetic Resonance Imaging; D012640:Seizures / Q000821:virology*; D051196:Toll-Like Receptor 3 / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D003287:Contrast Media; D016207:Cytokines; D051196:Toll-Like Receptor 3; D000212:Acyclovir