Abstract

Case Report

Herpes simplex virus (HSV)-1 encephalitis can induce chronic anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis

Susanne Buechner*, Gabriele J Sixt and Igor Florio

Published: 27 July, 2018 | Volume 2 - Issue 2 | Pages: 033-038

Herpes simplex virus (HSV)-1 encephalitis is the most common infectious cause of sporadic encephalitis. Despite treatment with acyclovir, HSV encephalitis is still associated with severe morbidity characterized by persistent neurological deficits. HSV encephalitis usually follows a monophasic course, however, some patients might develop relapsing symptoms caused by the formation of auto-antibodies directed against the N-methyl-D-aspartate receptor (NMDAR). Here we present an 82-year-old male patient with HSV encephalitis who developed shortly after his hospital discharge a Post-HSV NMDAR encephalitis, characterized by recurrent epileptic seizures and deterioration of his residual aphasia. First-line immunotherapy with intravenous immunoglobulins (IgIV) was administered and the patient returned almost to his baseline residual deficits of HSV encephalitis. Subsequently, he presented with recurrent relapses of NMDAR encephalitis. Since periodic treatment with IgIV has been started the patient is seizure-free and his neuropsychiatric condition is stable. In conclusion, the recognition of Post-HSV NMDAR encephalitis is very important because neurological manifestations can markedly improve with immunotherapy. Interestingly, in some patients cerebral HSV infection seems to trigger a chronic inflammatory disorder with persistent autoimmune activation which requires chronic treatment.

Read Full Article HTML DOI: 10.29328/journal.jnnd.1001012 Cite this Article Read Full Article PDF

Keywords:

Herpes simplex virus-1 encephalitis; Anti-NMDA receptor encephalitis; Post-viral autoimmune encephalitis; Epileptic seizures; Immunotherapy

References

  1. Bradshaw MJ, Venkatesan A. Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management. Neurotherapeutics. 2016; 13: 493-508. Ref.: https://tinyurl.com/y896nyme
  2. Nosadini M, Mohammad SS, Corazza F, Ruga EM, Kavitha Kothur, et al. Herpes simplex virus-induced anti-N-methyl-D-aspartate receptor encephalitis: a systemic literature review with analysis of 43 cases. Developmental Medicine & Child Neurology. 2017; 59: 796-805. Ref.: https://tinyurl.com/y9qoyq2r
  3. Armangue T, Moris G, Cantarin-Extremera V, Conde CE, Rostasy K, et at. Autoimmune post-herpes simplex encephalitis of adults and teenagers. Neurology. 2015; 85: 1736-1743. Ref.: https://tinyurl.com/y9r6hdfs
  4. Westman G, Studahl M, Ahlm C, Eriksson BM, Persson B, et al. N-methyl-D-aspartate receptor autoimmunity affects cognitive performance in herpes simplex encephalitis. Clin Microbiol Infect. 2016; 22: 934-940. Ref.: https://tinyurl.com/yd8m4na3
  5. Kovac S, Alferink J, Ahmetspahic D, Arolt V, Melzer N. Update Anti-N-Methyl-D-Aspartat-Rezeptor-Enzephalitis. Nervenarzt. 2018; 89: 99-112. Ref.: https://tinyurl.com/y9np7ye4
  6. Bien CG, Bauer J. Autoimmune Epilepsies. Neurotherapeutics. 2014; 11: 311-318. Ref.: https://tinyurl.com/y7hgfc2e
  7. Schein F, Gagneux-Brunon A, Antoine JC, Lavernhe S, Pillet S, et al. Anti-N-methyl-D-aspartate receptor encephalitis after Herpes simplex virus-associated encephalitis: an emerging disease with diagnosis and therapeutic challenges. Infection. 2017; 45: 545-549. Ref.: https://tinyurl.com/ycjcvyrd
  8. Linnoila JJ, Binnicker MJ, Majed M, Klein CJ, McKeon A. CSF herpes virus and autoantibody profiles in the evaluation of encephalitis. Neurol Neuroimmunol Neuroinflamm. 2016; 3: e245. Ref.: https://tinyurl.com/y8l4mlsb
  9. Popkirov S, Ismail FS, Grönheit W, Kapauer M, Wellmer J, et al. Progressive hippocampal sclerosis after viral encephalitis: Potential role of NMDA receptor antibodies. Seizure. 2017; 51: 6-8. Ref.: https://tinyurl.com/y83qkcmo
  10. Omae T, Saito Y, Tsuchie H, Ohno K, Maegaki Y, et al. Cytokine/chemokine elevation during the transition phase from HSV encephalitis to autoimmune anti-NMDA receptor encephalitis. Brain Dev. 2018; 40: 361-365. Ref.: https://tinyurl.com/yaqahfqb

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?