Herpes simplex myelitis in a patient with acquired immune deficiency syndrome

Area of Science:

• Neurology
• Infectious Diseases
• Virology

Background:

• Herpes simplex virus type 1 (HSV1) is a primary cause of focal encephalitis in immunocompetent adults.
• Ascending myelitis is a rare but serious neurological complication.

Purpose of the Study:

• To report a case of acute ascending myelitis progressing to encephalitis caused by HSV1.
• To emphasize the potential association between disseminated HSV1 central nervous system infection and HIV coinfection.

Main Methods:

• Clinical case presentation and neurological examination.
• Magnetic Resonance Imaging (MRI) of the brain and spine.
• Cerebrospinal fluid (CSF) analysis for HSV1 antibodies (IgM and IgG).
• Serum analysis for Human Immunodeficiency Virus (HIV) using ELISA and Western blot.

Main Results:

• A 35-year-old male presented with acute ascending myelitis, rapidly progressing to encephalitis within one week.
• MRI revealed non-hemorrhagic lesions in the frontotemporal areas and midbrain.
• CSF tested positive for HSV1 IgM and IgG antibodies.
• Serum tests confirmed HIV coinfection via ELISA and Western blot.
• The patient succumbed to resistant Pseudomonas aeruginosa septicemia.

Conclusions:

• Disseminated central nervous system involvement in HSV infection warrants suspicion of concurrent HIV coinfection.
• This case underscores the importance of considering HIV in patients with severe or atypical HSV neurological presentations.