title: Acyclovir-resistant herpes simplex encephalitis in a patient treated with anti-tumor necrosis factor-α monoclonal antibodies.
abstract: Herpes simplex virus is the most common cause of severe sporadic encephalitis. We report a case of herpes simplex type 1-encephalitis in a 50-year-old woman receiving anti-tumor necrosis factor-α monoclonal antibodies adalimumab. Although she was an acyclovir naïve patient, a mixed viral population (wild-type and acyclovir-resistant bearing a thymidine-kinase mutation) was identified in the cerebrospinal fluid. The virus in cerebrospinal fluid evolved and a second thymidine-kinase mutant virus emerged. Combined foscavir and acyclovir treatment resolved the herpes simplex encephalitis. To our knowledge, this is the first report of acyclovir-resistant herpes simplex encephalitis in a patient treated with adalimumab.
authors.affiliation: Department of Infectious Diseases, Université Libre de Bruxelles-ULB, Brussels, Belgium.
authors.forename: Kinda
authors.initials: K
authors.lastname: Schepers
authors.affiliation: Department of Neurology, Université Libre de Bruxelles-ULB, Brussels, Belgium.
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernandez
authors.affiliation: Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
authors.forename: Graciela
authors.initials: G
authors.lastname: Andrei
authors.affiliation: Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gillemot
authors.affiliation: Laboratory of Immunobiology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fiten
authors.affiliation: Laboratory of Immunobiology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
authors.forename: Ghislain
authors.initials: G
authors.lastname: Opdenakker
authors.affiliation: Department of Neurology, Université Libre de Bruxelles-ULB, Brussels, Belgium.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bier
authors.affiliation: Department of Radiology, Université Libre de Bruxelles-ULB, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: David
authors.affiliation: Laboratory of Virology, Université Libre de Bruxelles-ULB, Brussels, Belgium.
authors.forename: Marie-Luce
authors.initials: ML
authors.lastname: Delforge
authors.affiliation: Department of Infectious Diseases, Université Libre de Bruxelles-ULB, Brussels, Belgium.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Jacobs
authors.affiliation: Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium. Electronic address: robert.snoeck@rega.kuleuven.be.
authors.forename: Robert
authors.initials: R
authors.lastname: Snoeck
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage*; D000068879:Adalimumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000821:virology; D024882:Drug Resistance, Viral; D020803:Encephalitis, Herpes Simplex / Q000188:drug therapy*; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D018139:Simplexvirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D017245:Foscarnet; D000068879:Adalimumab; D000212:Acyclovir
keywords: Acyclovir-resistant herpes simplex; Adalimumab; Anti-tumor necrosis factor-α monoclonal antibodies; Herpes simplex encephalitis