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Pediatr Infect Dis J. 2014 Apr;33(4):424-6. doi: 10.1097/INF.0000000000000137.

Neonatal herpes simplex virus type-1 central nervous system disease with acute retinal necrosis.

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From the *Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya; †Paediatric and Child Health Research Group, University of Malaya Medical Centre; and ‡Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia.


We report a case of neonatal herpes simplex virus (HSV)-1 central nervous system disease with bilateral acute retinal necrosis (ARN). An infant was presented at 17 days of age with focal seizures. Cerebrospinal fluid polymerase chain reaction was positive for HSV-1 and brain magnetic resonance imaging showed cerebritis. While receiving intravenous acyclovir therapy, the infant developed ARN with vitreous fluid polymerase chain reaction positive for HSV-1 necessitating intravitreal foscarnet therapy. This is the first reported neonatal ARN secondary to HSV-1 and the first ARN case presenting without external ocular or cutaneous signs. Our report highlights that infants with neonatal HSV central nervous system disease should undergo a thorough ophthalmological evaluation to facilitate prompt diagnosis and immediate treatment of this rapidly progressive sight-threatening disease.

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