Herpes laryngitis and tracheitis causing respiratory distress in a neonate

A newborn presented 1 week after birth with the sudden onset of stridor and respiratory distress. At endoscopy, the supraglottic and subglottic tissues were edematous and erythematous, and numerous plaquelike ulcers were seen on the mucosal surface. Cultures of the lesions yielded herpes simplex virus type 2. The infant required a prolonged course of acyclovir and remained intubated for 31 days, but ultimately had both virological and clinical cure. Evaluation and further treatment of this unusual presentation of herpes simplex virus are discussed, as are the implications of herpes infections in neonates.