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Herpes simplex encephalitis: diagnostic problems and late relapse.

Xavier De Tiège1, Flore Rozenberg, Karine Burlot

  • 1Department of Paediatric Neurology, Hôpital Cochin-Saint Vincent de Paul, Paris, France.

Developmental Medicine and Child Neurology
|December 20, 2005
PubMed
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This case study highlights challenges in diagnosing herpes simplex encephalitis (HSE) in children. Delayed antibody detection and relapse suggest viral replication may occur when antibodies disappear.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Neuroimmunology

Background:

  • Herpes simplex encephalitis (HSE) is a severe neurological condition in children.
  • Early diagnosis and treatment are crucial for favorable outcomes.
  • Diagnostic challenges exist, particularly in atypical presentations.

Observation:

  • A 5-year-old presented with focal seizures and paralysis, initially with normal CSF and HSV PCR.
  • Cerebral MRI revealed thalamic and parietal lesions; delayed intrathecal anti-HSV antibody synthesis confirmed HSE.
  • A relapse occurred 20 months later with HSV DNA in CSF and disappearance of intrathecal antibody synthesis.

Findings:

  • Initial HSE diagnosis was delayed due to normal CSF findings and undetectable HSV DNA.

Related Experiment Videos

  • Delayed intrathecal synthesis of specific anti-HSV antibodies confirmed the initial diagnosis.
  • Relapse was associated with the disappearance of intrathecal antibody synthesis, suggesting a role in viral resurgence.

    • Implications:

    • This case underscores the importance of considering HSE even with initial negative tests.
    • Delayed antibody detection in CSF is a key diagnostic marker for HSE.
    • The disappearance of intrathecal antibody synthesis may predict or permit HSE relapse.