Neonatal Herpes Simplex Virus-1 Recurrence with Central Nervous System Disease in Twins after Completion of a Six-Month Course of Suppressive Therapy: Case Report

Abstract

Seventeen-day-old twins were hospitalized for neonatal herpes simplex virus 1 (HSV-1) with central nervous system disease and internal capsule and thalamic lesions on magnetic resonance imaging (MRI). They were treated with the usual intravenous (IV) treatment and oral therapy for 6 months. The clinical course was good in both children with negative HSV polymerase chain reaction on completion of IV therapy. The neurological condition recurred in one child with new radiological lesions at 7 months of age, 2 weeks after discontinuation of oral treatment. Cerebral lesions highlighted on the MRI scan are specific to the neonatal period and impact long-term prognosis. The likely genetic predisposition in this case is interesting and requires further investigation. In addition, this case raises questions about the duration of oral acyclovir suppressive therapy.

Keywords

recurrence of CNS disease - neonatal HSV infection - suppressive therapy

• References

• 1 Whitley RJ, Nahmias AJ, Soong SJ, Galasso GG, Fleming CL, Alford CA. Vidarabine therapy of neonatal herpes simplex virus infection. Pediatrics 1980; 66 (04) 495-501
• 2 Kimberlin DW, Whitley RJ, Wan W. , et al; National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Oral acyclovir suppression and neurodevelopment after neonatal herpes. N Engl J Med 2011; 365 (14) 1284-1292
• 3 Kato K, Hara S, Kawada J, Ito Y. Recurrent neonatal herpes simplex virus infection with central nervous system disease after completion of a 6-month course of suppressive therapy: case report. J Infect Chemother 2015; 21 (12) 879-881
• 4 Aymard M. [Current epidemiology of herpes]. Pathol Biol 2002; 50 (07) 425-435
• 5 Mandyla H, Anagnostakis D, Koutsovitis P, Siahanidou T, Youroukos S. Late recurrence of herpes simplex virus meningoencephalitis in two infants. Eur J Pediatr 2001; 160 (12) 732-735
• 6 Henderson B, Kimberlin DW, Forgie SE. Delayed recurrence of herpes simplex virus infection in the central nervous system after neonatal infection and completion of six months of suppressive therapy. J Pediatric Infect Dis Soc 2017; 6 (04) e177-e179
• 7 Fonseca-Aten M, Messina AF, Jafri HS, Sánchez PJ. Herpes simplex virus encephalitis during suppressive therapy with acyclovir in a premature infant. Pediatrics 2005; 115 (03) 804-809
• 8 Pinninti SG, Kimberlin DW. Preventing herpes simplex virus in the newborn. Clin Perinatol 2014; 41 (04) 945-955
• 9 Abel L, Plancoulaine S, Jouanguy E. , et al. Age-dependent Mendelian predisposition to herpes simplex virus type 1 encephalitis in childhood. J Pediatr 2010; 157 (04) 623-629 , 629.e1
• 10 Pérez de Diego R, Sancho-Shimizu V, Lorenzo L. , et al. Human TRAF3 adaptor molecule deficiency leads to impaired toll-like receptor 3 response and susceptibility to herpes simplex encephalitis. Immunity 2010; 33 (03) 400-411
• 11 Leib DA. Herpes simplex virus encephalitis: toll-free access to the brain. Cell Host Microbe 2012; 12 (06) 731-732
• 12 Okanishi T, Yamamoto H, Hosokawa T. , et al. Diffusion-weighted MRI for early diagnosis of neonatal herpes simplex encephalitis. Brain Dev 2015; 37 (04) 423-431