title: A case of herpes simplex-associated encephalitis after brain irradiation for lung cancer metastases.
abstract: BACKGROUND
  Encephalitis caused by Herpes Simplex Virus-1 is a devastating disease with high mortality and disability rates despite adequate treatment. No clear risk factors have been identified although iatrogenic immunosuppression has been suggested, among others.
  
  
  METHODS
  A 59-year-old male smoker was diagnosed with metastatic lung adenocarcinoma and was treated with brain and spinal irradiation. Ten days after the completion of radiotherapy and before initiating platinum-based front-line chemotherapy, he developed low grade fever and personality change. Over the next few days, high fever and refractory seizures developed and the patient was diagnosed with Herpes simplex-associated encephalitis after detection of viral DNA in the cerebrospinal fluid via polymerase chain reaction. Despite treatment with acyclovir, the patient remained comatose and died three months after the initial presentation.
  
  
  CONCLUSIONS
  This case illustrates a possible association between brain irradiation and increased risk for Herpes simplex-associated encephalitis. However, the underlying mechanisms have not been elucidated.
authors: Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece.
authors: Alexios
authors: A
authors: Matikas
authors: Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece.
authors: Emmanouil
authors: E
authors: Kontopodis
authors: Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece.
authors: George
authors: G
authors: Nintos
authors: Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece.
authors: Tryfon
authors: T
authors: Bilidas
authors: Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece.
authors: Diamantis P
authors: DP
authors: Kofteridis
authors: Department of Radiology, University Hospital of Heraklion, Heraklion, Greece.
authors: Efrosini Z
authors: EZ
authors: Papadaki
authors: Department of Radiation Oncology, University Hospital of Heraklion, Heraklion, Greece.
authors: Efrossini
authors: E
authors: Lyraraki
authors: Department of Neurology, University Hospital of Heraklion, Heraklion, Greece.
authors: Kassiani
authors: K
authors: Kanatsouli
authors: Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece georgsec@med.uoc.gr.
authors: Dimitrios
authors: D
authors: Mavroudis
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D016371:Cranial Irradiation / Q000009:adverse effects*; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D020803:Encephalitis, Herpes Simplex / Q000209:etiology*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis
chemical_list: D004279:DNA, Viral
keywords: Encephalitis; Herpes Simplex Virus; brain radiotherapy; immunosuppression; lung cancer