Herpes Simplex Virus-2 Myelitis Persistence of Viral Replication despite Resolution of Symptoms : Case Report and Review of the Literature

Abstract

Acute transverse myelitis is a neurological syndrome resulting from inflammation of the spinal cord [1]. it is characterized by a variety of presentations depending on the level at which the spinal cord is involved, the location of the lesions, and the affected tracts. Signs and symptoms are commensurate with motor, sensory, or autonomic dysfunction, including paraparesis, flaccidity, spasticity, sensory impairment, bladder, bowel, and sexual dysfunction [2]. the clinical course may be monophasic or recurrent with variable remission rates depending on the underlying etiology [3]. while the exact trigger for this inflammatory process is yet to be identified, several conditions seem to be associated with the occurrence of transverse myelitis. Among the infectious etiologies, Mycoplasma pneumoniae, Borrelia burgdorferi, Treponema pallidum, and various viral pathogens have been implicated, including hiV, influenza, rubella, mumps, and all herpes viruses [4-8]. the diagnosis is suspected based on clinical signs and symptoms and is usually confirmed with Mri signal abnormality in the spinal cord, cereobrospinal fluid (CSf) pleocytosis, or both [9]. transverse myelitis caused by herpes simplex virus-2 (hSV-2) is rare, and only a small number of cases have been reported in adults. herein, we report a case of transverse myelitis due to hSV-2, with persistent viral replication in the CSf despite complete neurological recovery. CASe repOrt An 85-year-old man with an unremarkable medical history presented to the emergency unit with bilateral lower extremity weakness of five days duration. the patient was unable to stand from a sitting position without help but did not complain of any pain. he denied headaches, neck pain, visual disturbances, facial asymmetry, upper extremity weakness, or paresthesias. he had normal bowel and bladder control but reported urinary frequency. he did not report a recent febrile illness and his family verified normal cognitive and mental function. upon review of systems, he described a history of a recurrent rash on the back and buttocks for the past 20 years, with a recent flare two weeks prior to presentation.