title: Herpes simplex encephalitis in glioma patients: a challenging diagnosis.
abstract: OBJECTIVE
  In recent years, herpes simplex encephalitis (HSE) has been reported with increasing frequency in settings of immunosuppression, such as acquired immunodeficiency, transplantation and cancer. As observed, in immunocompromised individuals HSE presents peculiar clinical and paraclinical features, and poorer prognosis.
  
  
  METHODS
  Here we describe a retrospective series of seven cases of HSE in patients with high-grade glioma (HGG), collected among three institutions in a 5-year period (during this time, a total of 1750 patients with HGG were treated).
  
  
  RESULTS
  Diagnosis of the condition was particularly challenging due to the confounding clinical presentation and the atypical biological findings. As a result, antiviral treatment was started with a sharp delay compared with immunocompetent hosts. Prognosis was poor, with high short-term mortality and severe residual disability in survivors.
  
  
  CONCLUSIONS
  The substantial incidence of HSE observed in our centres together with the difficulty in diagnosing the condition suggest that the incidence of this complication may be highly underestimated. The aim of our report is to strengthen the observation of HSE in patients with HGG and outline the key elements that may allow its diagnosis.
authors.affiliation: C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Pavia, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Berzero
authors.affiliation: C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris, France.
authors.forename: Anna Luisa
authors.initials: AL
authors.lastname: Di Stefano
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Dehais
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Sanson
authors.affiliation: Neuro-oncology Unit, C. Besta Neurological Institute, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gaviani
authors.affiliation: Neuro-oncology Unit, C. Besta Neurological Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Silvani
authors.affiliation: Neuro-oncology Unit, C. Besta Neurological Institute, Milan, Italy SC Neurologia, Ospedale A. Manzoni, Lecco, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salmaggi
authors.affiliation: C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vitali
authors.affiliation: C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Pavia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Diamanti
authors.affiliation: Molecular Virology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Baldanti
authors.affiliation: C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy.
authors.forename: Lisa Maria
authors.initials: LM
authors.lastname: Farina
authors.affiliation: C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy Department of Neuroscience, University of Pavia, Pavia, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Ceroni
authors.affiliation: C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Marchioni
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis*; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D020803:Encephalitis, Herpes Simplex / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005910:Glioma / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000998:Antiviral Agents
keywords: Clinical Neurology; Infectious Diseases; Neurooncology; Neurovirology; Radiotherapy