title: Herpes simplex virus-1 encephalitis induced by chemoradiotherapy and steroids in an esophageal cancer patient: a case report.
abstract: BACKGROUND
  Systemic chemotherapy combined with steroids used as prophylactic antiemetics have been reported to induce immunosuppression. Further, herpes simplex virus-1 (HSV-1) infection has been reported to occur in patients with small cell carcinomas after chemoradiotherapy that includes brain irradiation. Here, we report a case of HSV-1 encephalitis that occurred in a patient undergoing chemoradiotherapy for advanced esophageal cancer.
  
  
  METHODS
  A 77-year-old woman received chemoradiotherapy (5-fluorouracil, 700 mg/m(2); cisplatin, 70 mg/m(2); and radiotherapy, 60 Gy in total) for stage III esophageal cancer. The total radiation dose was administered concurrently with the first two courses of chemotherapy, together with dexamethasone as a prophylactic antiemetic. Two days before completion of the fourth course of chemotherapy, the patient developed acute neurological symptoms of disorientation, clouding of consciousness, and fever. T2-weighted magnetic resonance imaging showed a high intensity area in the bilateral temporal lobes and insular cortex. Furthermore, DNA PCR testing of cerebrospinal fluid showed clear positivity for HSV-1 DNA, and the patient was diagnosed with herpetic encephalitis. Intravenous administration of acyclovir for 3 weeks led to gradual improvement of consciousness, and the patient was able to respond to verbal cues.
  
  
  CONCLUSIONS
  In advanced esophageal cancer patients, standard treatment involves chemoradiotherapy and surgery. However, primary infection with or reactivation of endogenous latent HSV-1 in the brain cortex during chemoradiotherapy combined with administration of a steroid may compromise the benefits of treatment.
authors.affiliation: Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan. msaito@jichi.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kiyozaki
authors.affiliation: Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
authors.forename: Tamotu
authors.initials: T
authors.lastname: Obitsu
authors.affiliation: Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Imoto
authors.affiliation: Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Taniyama
authors.affiliation: Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Takata
authors.affiliation: Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Rikiyama
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage*; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects; D003907:Dexamethasone / Q000009:adverse effects; D020803:Encephalitis, Herpes Simplex / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D018259:Herpesvirus 1, Human / Q000187:drug effects / Q000472:pathogenicity; D006801:Humans; D008279:Magnetic Resonance Imaging; D013256:Steroids / Q000009:adverse effects
chemical_list: D013256:Steroids; D003907:Dexamethasone; D002945:Cisplatin; D005472:Fluorouracil; D000212:Acyclovir
keywords: Chemoradiotherapy; Encephalitis; Esophageal cancer; HSV-1