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Cerebral malakoplakia associated with neonatal herpes virus infection
1Department of Pathology, University of Missouri, Kansas City School of Medicine, Truman Medical Center 64108.
Abstract:
Cerebral malakoplakia has been recognized as a complication of probable neonatal herpes encephalitis and may be associated with persistent neurologic deficits including seizures. At autopsy, an eight-month-old boy had a discrete cystic gliotic lesion in his left inferior frontal lobe with malakoplakia. Perinatal herpetic cutaneous lesions were seen and were successfully treated with medication at two weeks of age. Subsequent discontinuation of his anti-epileptic drugs was followed by sudden unexpected death. Immunohistochemical stains and electron microscopy of his brain failed to reveal herpes simplex virus.
Insights
Neonatal herpes encephalitis can lead to cerebral malakoplakia and seizures. This case highlights a fatal outcome despite treatment, with no herpes virus detected post-mortem.
Area of Science:
- Neuropathology
- Neonatal Neurology
- Infectious Disease
Background:
- Cerebral malakoplakia is a rare complication of neonatal herpes encephalitis.
- Neonatal herpes encephalitis can result in long-term neurological issues, including seizures.
Observation:
- An eight-month-old infant presented with a cystic gliotic lesion and malakoplakia in the left inferior frontal lobe.
- The infant had a history of perinatal herpetic cutaneous lesions treated in the neonatal period.
- Following discontinuation of anti-epileptic drugs, the infant experienced sudden unexpected death.
Findings:
- Autopsy revealed a discrete cystic gliotic lesion with malakoplakia.
- Immunohistochemical stains and electron microscopy did not detect herpes simplex virus in the brain.
- The neuropathological findings raise questions about the etiology of cerebral malakoplakia in this case.
Implications:
- This case underscores the potential for severe neurological complications following neonatal herpes encephalitis.
- The absence of detectable herpes simplex virus warrants further investigation into the pathogenesis of cerebral malakoplakia.
- Understanding these associations is crucial for managing infants with a history of neonatal herpes and subsequent neurological deficits.