A case of relapsing herpes encephalitis after treatment with acyclovir for fourteen days

Abstract

Herpes simplex encephalitis(HSE) is the most common viral encephalitis and acyclovir is wee-known as the treatment of choice for HSE. Occasionally patient with HSE relapse after acyclovir treatment. We report a case of relapsing HSE after treatment with acyclovir for 14 days. Case : Twenty five year-old man developed fever and confusional mentation. Neurologic examination revealed sensory aphasia and meningeal irritation signs. CSF finding showed lymphocyte predominant pleocytosis(WBC 82/mm3) and high pressure(220mmH2O). Brain MRI showed high signal intensity at the left temporal lobe in T2 and diffusion weighted image(DWI). EEG revealed semiperiodic sharp waves at the left temporal region. In diagnostic impression of HSE, treatment with acyclovir continued for 2 weeks, and the patient`s symptom and CSF finding were improved. Few days after the completion of acyclovir treatment, the patient became stuporous and CSF finding indicated pleocytosis again . To confirm HSE, brain biopsy was performed and pathologic finding was compatible with HSE. We started additional treatment with acyclovir for 2 month, because DWI showed persistent high signal intensity at left hemisphere after additional 1 month treatment of acyclovir. Though the symptoms of patient improved, the patient had a several neurologic sequale such as motor aphasia and regression of behavior