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Chronic granulomatous herpes simplex encephalitis in children
Seth Love1, Philipp Koch, Horst Urbach
1Department of Neuropathology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, United Kingdom. seth.love@bris.ac.uk
Journal of Neuropathology and Experimental Neurology
|December 8, 2004
Summary
Herpes simplex encephalitis in children can lead to chronic, granulomatous inflammation with mineralization, a rarely recognized complication. This histological pattern may follow initial infection, impacting long-term neurological outcomes.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Herpes simplex encephalitis (HSE) is typically acute but can manifest chronically in children.
- Histological findings of chronic HSE are not well-documented.
Observation:
- Three pediatric cases of HSE with chronic sequelae are presented.
- Two children developed intractable epilepsy post-HSE, requiring neurosurgery.
- A third infant experienced a fatal outcome with severe necrotizing and mineralizing granulomatous encephalitis.
Findings:
- Biopsies revealed chronic granulomatous inflammation with mineralization in children with epilepsy post-HSE.
- One case showed persistent HSV-1 DNA and IgM antibodies in CSF, with florid inflammation and necrosis upon repeat biopsy.
- Necropsy confirmed severe, mineralizing granulomatous encephalitis in the fatal case.
Implications:
- Pediatric herpes simplex encephalitis can present with chronic granulomatous inflammation and mineralization.
- This histological pattern may be an under-recognized complication of early childhood HSV infections.
- Understanding these chronic sequelae is crucial for managing long-term neurological deficits in affected children.