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Herpes-simplex encephalitis in patients with onco-hematological disease
Building: Bourbon Cataratas Convention Centre, Foz do Iguaçu
Room: Iguazu II
Date: 2014-05-06 02:15 PM – 02:30 PM
Last modified: 2014-02-09
Abstract
Herpes-simplex encephalitis (HSE) is a well-known but rare complication in patients after bone marrow transplantation (BMT) or with CNS tumors. The aim of this study was to describe three patients with HSE during the course of an onco-hematological disease (OHD).
Material and methods: From a sample of 18 confirmed PCR-positive cases of HSE in CSF seen over a period of 12 years, three patients with OHD were identified.
Results: Underlying disease and treatment: brainstem tumor and radiation/steroid therapy(1), maxillary embryonal rhabdomyosarcoma with parameningeal invasion and chemotherapy(1), and ALL and post-BMT immunosuppression(1). The presenting symptom was altered consciousness in all and two patients had focal motor seizures. CSF showed pleocytosis with raised proteins in two. CFS was PCR-positive for HSV-II in two and HHV6 in one. Brain MRI showed hyperintense signal on T2 and FLAIR in the corticosubcortical regions while the frontal and temporoinsular regions were unenhanced. The image was bilateral in two and asymmetrical in one. Only one had a bleeding complication. The EEG showed periodic, lateralized, epileptiform discharges in two cases. The patients were put on IV acyclovir for 21 days. All patients showed severe motor and neurocognitive involvement after treatment that had not been present before HSE onset.
Conclusion: As in all acute encephalopathies, early diagnosis and treatment of HSE is crucial. Immunosuppression may play a role in the reactivation of HSV. Another mechanism may be the viral reactivation induced by radiotherapy, when this includes the Gasser ganglion, as in the brainstem tumor patient.
Material and methods: From a sample of 18 confirmed PCR-positive cases of HSE in CSF seen over a period of 12 years, three patients with OHD were identified.
Results: Underlying disease and treatment: brainstem tumor and radiation/steroid therapy(1), maxillary embryonal rhabdomyosarcoma with parameningeal invasion and chemotherapy(1), and ALL and post-BMT immunosuppression(1). The presenting symptom was altered consciousness in all and two patients had focal motor seizures. CSF showed pleocytosis with raised proteins in two. CFS was PCR-positive for HSV-II in two and HHV6 in one. Brain MRI showed hyperintense signal on T2 and FLAIR in the corticosubcortical regions while the frontal and temporoinsular regions were unenhanced. The image was bilateral in two and asymmetrical in one. Only one had a bleeding complication. The EEG showed periodic, lateralized, epileptiform discharges in two cases. The patients were put on IV acyclovir for 21 days. All patients showed severe motor and neurocognitive involvement after treatment that had not been present before HSE onset.
Conclusion: As in all acute encephalopathies, early diagnosis and treatment of HSE is crucial. Immunosuppression may play a role in the reactivation of HSV. Another mechanism may be the viral reactivation induced by radiotherapy, when this includes the Gasser ganglion, as in the brainstem tumor patient.
Keywords
acute encephalopathie, Herpes-simplex encephalitis, Immunosuppression
References
1. Graber J, et al.Herpes simplex encephalitis in patients with cancer. Neurooncol. 2011 05(2): 415-21.
2. Spacca B, et al. HSV encephalitis in a child with brain stem glioma: a rare complication of therapy. Case report and review of the neurosurgical literature. Childs Nerv Syst. 2007 ;23 (11):1347-50.
3.Provenzale J., et al.Clinical and imaging findings suggesting human herpesvirus 6 encephalitis.Pediatr Neurol. 2010;42 (1):32-40.
4. Arroyo HA.Bologna R. Encefalitis por Herpesvirus., Neurología Pediátrica Fejerman N. –Fernandez Alvarez E. Ed. Panamericana .3a edición.2007
5.Meyding-Lamadé, et al. Herpesvirus infections of the central nervous system in immunocompromised patients. Ther Adv Neurol Disord. 2012 ; 5(5): 279–96
2. Spacca B, et al. HSV encephalitis in a child with brain stem glioma: a rare complication of therapy. Case report and review of the neurosurgical literature. Childs Nerv Syst. 2007 ;23 (11):1347-50.
3.Provenzale J., et al.Clinical and imaging findings suggesting human herpesvirus 6 encephalitis.Pediatr Neurol. 2010;42 (1):32-40.
4. Arroyo HA.Bologna R. Encefalitis por Herpesvirus., Neurología Pediátrica Fejerman N. –Fernandez Alvarez E. Ed. Panamericana .3a edición.2007
5.Meyding-Lamadé, et al. Herpesvirus infections of the central nervous system in immunocompromised patients. Ther Adv Neurol Disord. 2012 ; 5(5): 279–96
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