A Herpes simplex virus-1 fatal encephalitis following chemo-radiotherapy, steroids and prophylactic cranial irradiation in a small cell lung cancer patient

Silvano, Giovanni; Lazzari, Grazia; Resta, Francesco; Buccoliero, Giovanni Battista; Pezzella, G.; Pisconti, Salvatore

doi:10.1016/j.lungcan.2007.01.031

Cited by 23 publications

(15 citation statements)

References 17 publications

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“…Remarkably, local immunosuppression induced by irradiation of olfactory, limbic, temporal lobe and/or trigeminal circuits may well predispose to HSVE [19][20][21]. Moreover, discontinuing steroids in these patients might lead to a more severe clinical picture [19][20][21]. These observations support both a more prevalent role of primary versus reactivation-dependent HSVE, and a local moreso than systemic immune mechanism in the pathogenesis of HSVE.…”

Section: Is Steroid Therapy a Risk Factor For Hsve?mentioning

confidence: 82%

“…However, it does not appear to influence HSVE incidence [17,18]. Remarkably, local immunosuppression induced by irradiation of olfactory, limbic, temporal lobe and/or trigeminal circuits may well predispose to HSVE [19][20][21]. Moreover, discontinuing steroids in these patients might lead to a more severe clinical picture [19][20][21].…”

Section: Is Steroid Therapy a Risk Factor For Hsve?mentioning

confidence: 99%

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A Systematic Review on the Role of Adjunctive Corticosteroids in Herpes Simplex Virus Encephalitis: Is Timing Critical for Safety and Efficacy?

2013

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Section: Is Steroid Therapy a Risk Factor For Hsve?mentioning

confidence: 82%

Section: Is Steroid Therapy a Risk Factor For Hsve?mentioning

confidence: 99%

A Systematic Review on the Role of Adjunctive Corticosteroids in Herpes Simplex Virus Encephalitis: Is Timing Critical for Safety and Efficacy?

2013

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“…The HSV-reactivation presented as an atypical manifestation of HSV-1 encephalitis without the temporally and frontally accentuated haemorrhagic necroses which are typically observed on imaging and autopsy. Such atypical manifestations of HSV-1 encephalitis can be observed in immunosuppressed or critically ill patients [19][20][21] and impede making the correct diagnosis. Histological examination demonstrated pronounced lymphocytic meningoencephalitis with immunohistochemical detection of HSV-1 antigens.…”

Section: Discussionmentioning

confidence: 99%

Travel-associated neurological disease terminated in a postmortem diagnosed atypical HSV-1 encephalitis after high-dose steroid therapy – a case report

Osterman

Ruf²,

Domingo

et al. 2020

BMC Infect Dis

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Background: Human encephalitis can originate from a variety of different aetiologies, of which infection is the most common one. The diagnostic work-up is specifically challenging in patients with travel history since a broader spectrum of unfamiliar additional infectious agents, e. g. tropical disease pathogens, needs to be considered. Here we present a case of encephalitis of unclear aetiology in a female traveller returning from Africa, who in addition developed an atypical herpes simplex virus (HSV) encephalitis in close temporal relation with high-dose steroid treatment. Case presentation: A previously healthy 48-year-old female presented with confusion syndrome and impaired vigilance which had developed during a six-day trip to The Gambia. The condition rapidly worsened to a comatose state. Extensive search for infectious agents including a variety of tropical disease pathogens was unsuccessful. As encephalitic signs persisted despite of calculated antimicrobial and antiviral therapy, high-dose corticosteroids were applied intravenously based on the working diagnosis of an autoimmune encephalitis. The treatment did, however, not improve the patient's condition. Four days later, bihemispheric signal amplification in the insular and frontobasal cortex was observed on magnetic resonance imaging (MRI). The intracranial pressure rapidly increased and could not be controlled by conservative treatment. The patient died due to tonsillar herniation 21 days after onset of symptoms. Histological examination of postmortem brain tissue demonstrated a generalized lymphocytic meningoencephalitis. Immunohistochemical reactions against HSV-1/2 indicated an atypical manifestation of herpesviral encephalitis in brain tissue. Moreover, HSV-1 DNA was detected by a next-generation sequencing (NGS) metagenomics approach. Retrospective analysis of cerebrospinal fluid (CSF) and serum samples revealed HSV-1 DNA only in specimens one day ante mortem.

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“…However, clinical manifestations in immunocompromised hosts may be atypical, leading to delays in initiating therapy and to excess mortality (65). Whole-brain irradiation is increasingly recognized as a risk factor for HSV-1 encephalitis (66)(67)(68). In contrast, HSV-2 is a relatively infrequent cause of encephalitis but is associated with both meningitis and myelitis (69).…”

Section: Herpes Virusesmentioning

confidence: 99%

Central Nervous System Infections

2016

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A Herpes simplex virus-1 fatal encephalitis following chemo-radiotherapy, steroids and prophylactic cranial irradiation in a small cell lung cancer patient

Cited by 23 publications

References 17 publications

A Systematic Review on the Role of Adjunctive Corticosteroids in Herpes Simplex Virus Encephalitis: Is Timing Critical for Safety and Efficacy?

A Systematic Review on the Role of Adjunctive Corticosteroids in Herpes Simplex Virus Encephalitis: Is Timing Critical for Safety and Efficacy?

Travel-associated neurological disease terminated in a postmortem diagnosed atypical HSV-1 encephalitis after high-dose steroid therapy – a case report

Central Nervous System Infections

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