A Rare Case: Herpes Simplex Encephalitis

Öz

Herpes Simplex Encephalitis (HSE) is one of the most common causes of sporadic encephalitis and has the most mortal progression. A 22-year-old female patient applied to the emergency department with nausea and vomiting that lasted three days. The patient Cerebrospinal Fluid (CSF) was clear, the glucose ratio was low, and the protein ratio was high in the Lumbar Puncture (LP). HSV-DNA tests were requested with CSF culture and Polymerase Chain Reaction (PCR). Based on the LP results, and considering viral encephalitis, acyclovir treatment was started. The patient died on the 5th day while her treatment was continuing. HSV-DNA with PCR in BOS is the gold standard for the diagnosis of HSE. The most effective agent in treatment is acyclovir. The prognosis of the disease is poor.

Anahtar Kelimeler

• Encephalitis
• herpes
• vomiting

Nadir Bir Olgu: Herpes Simpleks Ensefaliti

Öz

Herpes Simplex Ensefaliti (HSE), sporadik ensefalitin sık nedenlerinden birisi ve en ölümcül seyredenidir. 22 yaşında kadın hasta, son üç gündür olan bulantı ve kusma şikayeti ile acil servise başvurdu. Lomber Ponksiyonda (LP) hastanın Beyin Omurilik Sıvısı (BOS) berrak görünümdeydi, glikoz oranı düşük ancak protein oranı yüksekti. BOS kültürü ve Polimeraz Zincir Reaksiyonu (PCR) ile HSV-DNA testleri istendi. LP sonuçları desteğinde viral ensefalit düşünülerek asiklovir tedavisi başlandı. Hasta 5. günde tedavisi devam ederken öldü. BOS'ta PCR ile HSV-DNA testi HSE teşhisi için altın standarttır. Tedavide en etkili ajan asiklovirdir. Hastalığın prognozu kötüdür.

Anahtar Kelimeler

• Ensefalit
• Herpes
• Kusma

Kaynakça

1. Jørgensen LK, Dalgaard LS, Østergaard LJ, Norgaard M, Mogensen TH. Incidence and mortality of herpes simplex encephalitis in Denmark: a nationwide registry-based cohort study. J Infect. 2017;74(1):42-9.
2. Granerod J, Cousens S, Davies NW, Crowcroft NS, Thomas SL. New estimates of incidence of encephalitis in England. Emerg Infect Dis. 2013;19(9):1455–1462.
3. Jennische E, Eriksson CE, Lange S, Trybala E, Bergström T. The anterior commissure is a pathway for contralateral spread of herpes simplex virus type 1 after olfactory tract infection. J Neurovirol. 2015;21(2):129-47.
4. Riancho J, Delgado-Alvarado M, Sedano MJ, Polo JM, Berciano J. Herpes simplex encephalitis: clinical presentation, neurological sequelae and new prognostic factors. Ten years of experience. Neurol Sci. 2013;34:1879-81.
5. Bradshaw MJ, Venkatesan A. Herpes simplex Virus-1 encephalitis in adults: pathophysiology, diagnosis, and management. Neurotherapeutics. 2016;13(3):493-508.
6. Misra UK, Kalita J, Phadke RV, Wadwekar V, Boruah DK, Srivastava A, et al. Usefulness of various MRI sequences in the diagnosis of viral encephalitis. Acta Trop. 2010;116:206-11.
7. Sawlani V. Diffusion-weighted imaging and apparent diffusion coefficient evaluation of herpes simplex encephalitis and Japanese encephalitis. J Neurol Sci. 2009;287:221-6.
8. Steiner I, Schmutzhard E, Sellner J, Chaudhuri A, Kennedy PGE. EFNS-ENS guidelines for the use of PCR technology for the diagnosis of infections of the nervous system. Eur J Neurol. 2012;19:1278-91.

9. Armangue T, Leypoldt F, Malaga I, Raspall-Chaure M, Marti I, Nichter C, et al. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol. 2014;75:317-323.
10. Solomon T, Michael BD, Smith PE, Sanderson F, Davies NWS, Hard IJ, et al. Management of suspected viral encephalitis in adults—Association of British Neurologists and British Infection Association National Guidelines. J Infect. 2012;64:347-73.
11. Steiner I, Benninger F. Update on herpes virus infections of the nervous system. Curr Neurol Neurosci Rep. 2013;13(12):414.