Herpes simplex virus type 2 encephalitis in two homosexual men with persistent lymphadenopathy

Area of Science:

• Neurology
• Infectious Diseases
• Virology

Background:

• Persistent lymphadenopathy can be associated with opportunistic infections in immunocompromised individuals.
• Herpes simplex virus (HSV) encephalitis is a severe neurological condition.
• Homosexual men with persistent lymphadenopathy may be at increased risk for certain infections.

Observation:

• Two homosexual men presented with symptoms of HSV encephalitis, including altered mental status and seizures.
• Cerebrospinal fluid analysis revealed pleocytosis, and EEG showed temporal lobe abnormalities.
• Initial CT scans were normal, but temporal lobe biopsies confirmed HSV type 2 infection.

Findings:

• Cultures of brain biopsy tissue from both patients yielded HSV type 2.
• Antiviral treatment with adenine arabinoside followed by acyclovir was administered.
• Both patients experienced gradual recovery after a second course of acyclovir but had significant neurological deficits.

Implications:

• This case series suggests a potential increase in HSV type 2 encephalitis among homosexual men with persistent lymphadenopathy or acquired immune deficiency syndrome (AIDS).
• Rapid diagnosis using HSV type 2 antibody immunofluorescence testing on brain biopsy tissue is crucial.
• Prompt and potentially aggressive antiviral therapy is essential for managing HSV encephalitis in this population.