title: Herpes simplex type 2 encephalitis and methotrexate medication: a fortuitous or causative association in a patient with spondyloarthritis?
abstract: It is unclear whether immunosuppression is a risk factor for herpes encephalitis. Herein, we describe a rare case of herpes simplex virus type 2 encephalitis in a patient treated with low-dose methotrexate for HLA-B27-associated spondyloarthritis. The patient was successfully treated with acyclovir but presented sequelae of encephalitis. Here we discuss the possible role of low-dose methotrexate therapy as a risk factor of neurological herpes reactivation and severe disease. The host-related and viral risk factors are also addressed.
authors.affiliation: Laboratory of Virology, University Hospital of Grenoble, Grenoble, France.|Institut de Biologie Structurale, CEA, CNRS, University Grenoble Alpes, Grenoble, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Lupo
authors.affiliation: Infectious Diseases Department, University Hospital of Grenoble, Grenoble, France.
authors.forename: Ophélie
authors.initials: O
authors.lastname: Dos Santos
authors.affiliation: Laboratory of Virology, University Hospital of Grenoble, Grenoble, France.|Institut de Biologie Structurale, CEA, CNRS, University Grenoble Alpes, Grenoble, France.
authors.forename: Raphaele
authors.initials: R
authors.lastname: Germi
authors.affiliation: Laboratory of Virology, University Hospital of Grenoble, Grenoble, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Baccard-Longère
authors.affiliation: Infectious Diseases Department, University Hospital of Grenoble, Grenoble, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Stahl
authors.affiliation: Infectious Diseases Department, University Hospital of Grenoble, Grenoble, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Epaulard
authors.affiliation: Laboratory of Virology, University Hospital of Grenoble, Grenoble, France.|Institut de Biologie Structurale, CEA, CNRS, University Grenoble Alpes, Grenoble, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Morand
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D000075203:Contraindications, Drug; D020803:Encephalitis, Herpes Simplex / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology / Q000473:pathology; D015870:Gene Expression; D015796:HLA-B27 Antigen / Q000235:genetics / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology
chemical_list: D000998:Antiviral Agents; D015796:HLA-B27 Antigen; D007166:Immunosuppressive Agents; D000212:Acyclovir; D008727:Methotrexate