Herpes simplex encephalitis presenting after steroid treatment of panuveitis

Wittles, K Nadia; Goold, Lucy A; Gilhotra, Jagjit S

doi:10.5694/j.1326-5377.2011.tb03216.x

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Three of the cases were found to have positive HSV-1 PCR testing on both vitreous and CSF samples, one of which was found on post-mortem testing. 12 , 13 , 14 The fourth case report had positive HSV-1 PCR testing of a vitreous sample, however there was no mention of CSF PCR HSV testing. 15 Three of these patients had been receiving systemic steroids and one was chronically immunosuppressed.…”

Section: Discussionmentioning

confidence: 99%

Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis

Haghnegahdar

Pennipede

Massey

et al. 2022

American Journal of Ophthalmology Case Reports

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Section: Discussionmentioning

confidence: 99%

Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis

Haghnegahdar

Pennipede

Massey

et al. 2022

American Journal of Ophthalmology Case Reports

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“…However, in our patient, he only took intravenous methylprednisolone, 120 mg/day for 3 days and very soon, his ocular symptoms progressively deteriorated and he had a seizure 8 days following the development of the first symptoms of ARN. Granulomatous uveitis, [14] retinal vasculitis, [15] and panuveitis were initially suspected respectively in these 3 cases, resulting in delayed antiviral treatment. It is assumed that single use of steroids without antiviral protection may lead to reactivation and duplication of latent virus, and thus spread to the brain and the contralateral eye.…”

Section: Discussionmentioning

confidence: 99%

“…It is assumed that single use of steroids without antiviral protection may lead to reactivation and duplication of latent virus, and thus spread to the brain and the contralateral eye. [14] It has been generally accepted that the earlier initiation of acyclovir in suspected HSE patients, the better prognosis of this catastrophic disease might be. [16,17] Therefore, we treated this patient empirically with acyclovir soon after the initial diagnostic evaluation.…”

Section: Discussionmentioning

confidence: 99%

Fulminant bilateral acute retinal necrosis complicated with secondary herpes simplex type-1 viral encephalitis

Ye¹,

Ding²,

Shen³

et al. 2019

Medicine

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Rationale:Acute retinal necrosis (ARN), which is characterized by peripheral necrotizing retinitis, severe retinal arteritis, and progressive inflammatory reaction in the vitreous and anterior chambers, has been reported in cases with herpes simplex encephalitis (HSE). It is a relatively rare complication secondary to HSE. However, cases presented with viral encephalitis following ARN were seldom reported.Patient concerns:A 43-year-old immunocompetent male patient manifested the aforesaid reverse situation. He developed HSE following 3-day systemic steroid therapy for abrupt ocular pain and rapidly decreased visual acuity, which was later diagnosed as ARN. Polymerase chain reaction (PCR) analysis of vitreous specimen verified herpes simplex virus-1 (HSV-1) infection.Diagnosis:HSE associated with ARN.Interventions:The patient was treated with intravenous acyclovir (500 mg every 8 h) for 21 days. A pulse of intravenous methylprednisolone, 500 mg/d for 5 days was given as an anti-inflammatory therapy, followed by prednisone taper.Outcomes:The patient's neurological symptoms got improved very soon after the therapy, but his vision acuity remained no perception of light in both eyes.Lessons:The present case indicates that ARN can also be a risk factor for HSE. Once ARN was suspected, corticosteroid should be applied with caution and in combination with antiviral treatment to avoid progressive duplication of virus and its spread to the brain.

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“…Owing to their anti-inflammatory and immunomodulatory effects, glucocorticoids might in theory increase the rate of viral replication, but experimental animal models have yielded conflicting results regarding their effect on replication and clearance of HSV in the CNS [ 4 , 5 ]. Case reports have shown temporal associations between steroids and HSVE, but the relative contribution of steroids remains unclear because other factors, such as concomitant chemotherapy [ 6 , 7 ] or direct insult to the CNS (radiation [ 8 ], surgery [ 9 , 10 ]) or close structures (eye [ 11 , 12 ]), may have contributed to the HSVE in most of these cases. Here, we present a case of HSV-1 meningoencephalitis that developed following pulse-dose steroids for the treatment of interstitial lung disease in a patient with no history of chemotherapy or CNS insult.…”

Section: Introductionmentioning

confidence: 99%

Herpes Simplex Virus Meningoencephalitis Following Pulse-Dose Methylprednisolone: A Case Report and Literature Review

et al. 2021

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Patient: Male, 76-year-old Final Diagnosis: Herpes simplex virus type 1 (HSV-1) encephalitis Symptoms: Encephalopathy Medication: — Clinical Procedure: Lumbar puncture Specialty: Critical Care Medicine Objective: Unusual or unexpected effect of treatment Background: Several cases of herpes simplex virus type 1 meningoencephalitis (HSVE) have been reported in patients receiving steroids, but the exact contribution of steroids to the disorder remains unclear because other risk factors, such as chemotherapy, brain radiation, or surgery, were present in almost all cases. Case Report: We report the case of a 76-year-old man who developed HSVE following the administration of pulse-dose steroids. The patient had occupational asbestos exposure and a chronic interstitial lung disease of unclear etiology (sarcoidosis versus hypersensitivity pneumonitis) and was admitted for acute-on-chronic respiratory failure requiring mechanical ventilation. After a negative infectious workup and several days of antibiotics without improvement, pulse-dose steroids were administered. In the following days, the patient developed a fever and worsening encephalopathy. A lumbar puncture showed elevated nucleated cells and positive polymerase chain reaction for herpes simplex virus 1 in the cerebrospinal fluid, confirming the diagnosis of HSVE. Acyclovir treatment was initiated, but the patient later died as a result of persistent severe encephalopathy and respiratory failure with an inability to wean mechanical ventilation. Conclusions: Clinicians should keep in mind that HSVE is a potential complication of steroids and carefully consider the benefit/risk ratio of pulse-dose steroids, taking into account associated factors of immunosuppression. A high level of awareness should be especially maintained in critically ill patients because of associated risk factors (critical illness immune paralysis) and because neurological signs of HSVE may be missed in mechanically ventilated, sedated patients.

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Herpes simplex encephalitis presenting after steroid treatment of panuveitis

Cited by 5 publications

References 10 publications

Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis

Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis

Fulminant bilateral acute retinal necrosis complicated with secondary herpes simplex type-1 viral encephalitis

Herpes Simplex Virus Meningoencephalitis Following Pulse-Dose Methylprednisolone: A Case Report and Literature Review

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