Atypical Neuroimaging Features of Herpes Simplex Virus-2 Encephalitis

Excerpt

To the Editor: A 13-mo-old boy presented with irritability and swaying of the trunk and neck for two days. Five days before presentation, there was history of transient fever and vesicular lesion on scalp lasting for two days. At presentation, child had features of elevated intracranial pressure, developed focal seizures, and altered sensorium. Child was managed as acute febrile encephalopathy with raised intracranial pressure and initiated on intravenous ceftriaxone and acyclovir. A contrast enhanced brain MRI revealed T2/FLAIR hyperintense lesions predominantly affecting gray matter in the temporal, occipital, and parietal lobes with diffusion restriction (Supplementary Fig. S1). The child's cerebrospinal fluid revealed 30 cells (monocytic), protein of 130 mg/dL and glucose 40 mg/dL. The PCR for Herpes simplex virus-2 (HSV-2) was positive and autoimmune panel was negative. Intravenous acyclovir was continued for 14 d along with supportive care. The child showed improvement in sensorium and was discharged within 3 wk but continues to have neurological deficits. …