Hyperleukocytosis in a premature infant with intrauterine herpes simplex encephalitis

Abstract

Herpes encephalitis is a rare but devastating infection in premature infants. We report a 29 week gestation infant with severe intrauterine cutaneous and central nervous system herpes accompanied by hyperleukocytosis. Leukemoid reactions are not uncommon in this population, but the association of herpes encephalitis and a leukemoid reaction or hyperleukocytosis has not been reported previously.

Discordant Transient Extreme Hyperleukocytosis in Dichorionic Diamniotic Twins

“…Although the exact causative mechanism is still unclear, several hypotheses are documented in the literature, of which chorioamnionitis, 2,8,9 perinatal infection, 6,10,11 and the administration of ACS 12-14 seem to be the most important triggers.…”

Ascending in Utero Herpes Simplex Virus Infection in an Initially Healthy-Appearing Premature Infant

“…In a recent review, Marquez and col leagues [l] found only 64 cases, including 3 of their own, and fewer than 10 cases have been reported in the ensuing 5 years [2][3][4][5][6][7], Fetal loss can occur in utero and, despite appropriate treatment, the case fatality rate approaches 50%. The triad of cutaneous, CNS, and ophthalmologic manifestations is helpful in establishing the diagnosis, but these are not reliably present, and other sites of involvement such as visceral, limb, and bone abnormal ities can alert clinicians to consider the diagnosis [1], Most infants diagnosed with intrauterine HSV infection are ill or have findings leading to initiation of a diagnostic evaluation for congenital infection at birth.…”

“…Intrauterine HSV infection is uncommon and the clinical presentation can vary, but failure to recognize congenitally acquired HSV infection can have devastating consequences. In a recent review, Marquez and colleagues [1] found only 64 cases, including 3 of their own, and fewer than 10 cases have been reported in the ensuing 5 years [2][3][4][5][6][7]. Fetal loss can occur in utero and, despite appropriate treatment, the case fatality rate approaches 50%.…”

An Unusual Presentation of Neonatal Sepsis as Hyperleukocytosis With Firm Lymphadenopathy: A Diagnostic Challenge

“…During his NICU stay, the baby developed septicemia, following which his counts were suggestive of a leukemoid reaction. A case of leukemoid reaction following herpes infection was reported by Underwood et al in a baby [ 11 ]. In our case, also, the cause of hyperleukocytosis was secondary to bacterial sepsis.…”