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No patient was clinically suspected of having HSE, only one received acyclovir (for concurrent mucocutaneous herpes) and HSE played a major role in all deaths. Autopsy revealed an unusual form of HSE characterized by a noninflammatory, pseudoischemic histological presentation and the unexpected persistence of viral antigens in abundance despite survival beyond the clinical stage during which inflammatory responses usually peak and productive brain infection wanes. The incidence of HSE in the immunocompromised may be underestimated. Preexistent neurological disease, a noninflammatory CSF profile and negative CT scan may confound the diagnosis in this population, a typical clinical presentation notwithstanding. Increased clinical suspicion, the use of magnetic resonance imaging and polymerase chain reaction analysis of CSF for herpes simplex virus nucleic acid sequences may permit more rapid diagnosis and treatment. The absence of inflammatory infiltrates in some fatal cases of HSE suggests that an intact immune response is not requisite to the devastating neurological injury characteristic of this disorder. |
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carcinoma
CAT scan
CAT scan,false negative
central nervous system,infection,cancer patient
cerebrospinal fluid
cerebrospinal fluid,cell count,normal
coma
fever
glioblastoma multiforme(astrocytoma Gr.III)
herpes labialis
herpes simplex encephalitis
herpes simplex encephalitis,atypical
herpes simplex virus infection,immunosuppressed patient
herpes simplex,neurocutaneous lesions in
Horner's syndrome
human immunodeficiency virus type 1
immunosuppression
inclusion bodies
inclusion bodies,eosinophilic intranuclear
lethargy
level of consciousness,decreased
lymphoma
lymphoma,primary of CNS
mortality
opportunistic infection
opportunistic infection,CNS
PLEDs
pleocytosis of cerebrospinal fluid
polymerase chain reaction
seizure
serologic testing
serologic testing,false negative
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