Neonatal herpes simplex virus death manifested as rapidly progressive pneumonia

This report describes a case of probable herpes simplex virus (HSV) pneumonia in a neonate with no other localized signs of HSV infection. A 37-week-old infant became ill on the fourth day of life and died 6 days later of overwhelming pneumonia and ensuing complications. After the infant's death, viral cultures from the trachea, nasopharynx, and gastric aspirate grew herpes simplex virus. The mother had no history or signs of HSV infection at delivery. She developed a postpartum fever, and 8 days later herpetic lesions were noticed on the vulva and buttocks. The source of this infant's infection was most likely the maternal birth canal. Nosocomial acquisition could not be ruled out, but no history of HSV infection was found in either involved hospital personnel or in 38 infants defined to be at risk for nosocomial acquisition of the disease. Neonatal HSV can present as a rapidly progressive pneumonia without other clues to etiology.