[Herpes simplex myelitis in an immunocompetent adult patient]

Herpes simplex-1 virus myelitis is a rare cause of myelitis in immunocompetent adults.

A healthy man in his sixties presented with acute chest pain, dyspnoea and cardiac arrest. Pre-hospital cardiopulmonary resuscitation was performed, and he underwent thrombolysis. Intrahospital he was diagnosed with bilateral pulmonary embolism. Twelve days after hospitalisation he developed acute paralysis of the lower extremities. MR findings were suggestive of myelitis, and herpes simplex-1 virus was identified in the spinal fluid. He was diagnosed with herpes simplex myelitis and treated with intravenous acyclovir for 28 days and methylprednisolone for five days, without resolution of symptoms.

We found no causal relationship between pulmonary embolism and herpes simplex myelitis. Our hypothesis is that the severe stress caused by the initial pulmonary embolism and cardiac arrest triggered reactivation of herpes simplex-1 virus.