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Pediatr Neurol. 2014 Apr;50(4):392-6. doi: 10.1016/j.pediatrneurol.2013.12.008. Epub 2013 Dec 14.

Granulomatous herpes simplex encephalitis in an infant with multicystic encephalopathy: a distinct clinicopathologic entity?

Author information

1
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. Electronic address: peter.schutz@vch.ca.
2
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Pathology, Red Deer Regional Hospital, Red Deer, Canada.
3
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, Canada.
4
Department of Radiology, University of British Columbia, Vancouver, Canada.
5
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada.
6
Department of Pediatrics, University of British Columbia, Vancouver, Canada.

Abstract

BACKGROUND:

Herpes simplex virus encephalitis can manifest as a range of clinical presentations including classic adult, neonatal, and biphasic chronic-granulomatous herpes encephalitis.

METHOD:

We report an infant with granulomatous herpes simplex virus type 2 encephalitis with a subacute course and multicystic encephalopathy.

CASE:

A 2-month-old girl presented with lethargy and hypothermia. Computed tomography scan of the head showed multicystic encephalopathy and calcifications. Cerebrospinal fluid analysis by polymerase chain reaction testing for herpes simplex virus 1 and 2, enterovirus, and cytomegalovirus was negative. Normal cerebrospinal fluid interferon-α levels argued against Aicardi-Goutières syndrome. The patient died 2 weeks after presentation. At autopsy, multicystic encephalopathy was confirmed with bilateral gliosis, granulomatous inflammation with multinucleated giant cells, and calcifications. Bilateral healing necrotizing retinitis suggested a viral etiology, but retina and brain were free of viral inclusions and immunohistochemically negative for herpes simplex virus-2 and cytomegalovirus. However, polymerase chain reaction analysis showed herpes simplex virus-2 DNA in four cerebral paraffin blocks. Subsequent repeat testing of the initial cerebrospinal fluid sample using a different polymerase chain reaction assay was weakly positive for herpes simplex virus-2 DNA.

CONCLUSION:

Granulomatous herpes simplex virus encephalitis in infants can present with subacute course and result in multicystic encephalopathy with mineralization and minimal cerebrospinal fluid herpes simplex virus DNA load. Infectious etiologies should be carefully investigated in the differential diagnosis of multicystic encephalopathy with mineralization, in particular if multinucleated giant cells are present.

KEYWORDS:

Aicardi-Goutières syndrome; cerebral mineralization; encephalitis; herpes simplex virus; multicystic encephalopathy; necrotizing retinitis; neurotransmitter abnormality

[Indexed for MEDLINE]

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