Late-Onset HSV-2 Encephalitis in a Kidney Transplant Recipient: A Rare Case Report

Area of Science:

• Nephrology
• Infectious Diseases
• Virology

Background:

• Renal transplant recipients are susceptible to infections, with viral pathogens like herpes simplex virus (HSV) posing significant risks.
• Herpes simplex virus type 2 (HSV-2) reactivation is common in immunosuppressed patients, often presenting asymptomatically or as genital herpes.
• Severe neurological complications, including encephalitis, can arise from HSV-2, particularly early post-transplant, carrying a high mortality rate.

Observation:

• A 49-year-old male kidney transplant recipient presented with acute neurological symptoms including aphasia and disorientation three years post-transplant.
• Cerebrospinal fluid (CSF) analysis using polymerase chain reaction (PCR) confirmed HSV-2 as the causative agent.
• The patient received intravenous acyclovir, with dosage adjusted for renal function.

Findings:

• Polymerase chain reaction (PCR) is crucial for diagnosing viral encephalitis, especially in immunosuppressed individuals with atypical presentations.
• Early and accurate diagnosis of HSV-2 encephalitis enabled prompt treatment.
• The patient achieved complete neurological recovery with negative follow-up CSF PCR results.

Implications:

• This case highlights the importance of considering HSV-2 encephalitis in the differential diagnosis of neurological symptoms in transplant patients, even beyond the early post-transplant phase.
• The study underscores the critical role of PCR diagnostics as the gold standard for identifying viral pathogens in neurological infections.
• Multidisciplinary approaches and early recognition are vital for improving outcomes in this immunocompromised population.