title: Extratemporal herpes encephalitis during natalizumab treatment: A case report.
abstract: Herpes simplex virus encephalitis (HSE) is a rare but often fatal disease if left untreated. MRI typically shows the characteristic findings of medial temporal lobe and insular involvement, while diagnosis in confirmed by CSF PCR. In immunocompromised state, HSE may have atypical clinical and radiological features. We report a MS patient under natalizumab treatment with HSE, who presented with MRI lesions exclusively in the right parietal lobe. The patient was timely started on acyclovir resulting in marked improvement. A high index of suspicion for HSE should be maintained when a patient presents with fever and extratemporal lesions, even more in immunocompromised subjects.
authors.affiliation: Multiple Sclerosis Clinical Centre, San Camillo-Forlanini Hospital, Rome, Italy. Electronic address: s.haggiag@scf.gov.it.
authors.forename: Shalom
authors.initials: S
authors.lastname: Haggiag
authors.affiliation: Dept. of Neurology and Psychiatry, Sapienza University, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Prosperini
authors.affiliation: Multiple Sclerosis Clinical Centre, San Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Galgani
authors.affiliation: Dept. of Neurology and Psychiatry, Sapienza University, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pozzilli
authors.affiliation: Clinical Department, National Institute of Infectious Disease "Lazzaro Spallanzani", Rome, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Pinnetti
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D020803:Encephalitis, Herpes Simplex / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D000069442:Natalizumab / Q000009:adverse effects* / Q000627:therapeutic use; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D007155:Immunologic Factors; D000069442:Natalizumab; D000212:Acyclovir
keywords: Encephalitic; HSV-1; Multiple sclerosis; Natalizumab