Uncommon complications of herpes simplex encephalitis in a 7 year old child in Iran: A case report

HSV-induced encephalitis is one of the most common viral encephalitis in children with known signs and symptoms, including personality changes, fever, impaired consciousness and focal neurological deficits. Imaging findings also include temporal lobe and fronto-orbital involvement. In the present study, we present a 7-year-old girl diagnosed with HSV1-induced herpes encephalitis with unusual symptoms. Case presentation:A 7-year-old girl was transferred to the emergency department of our hospital with loss of consciousness. The patient had symptoms of colds for three days. The patient then had a seizure attack (generalized tonic-clonic) 2 hours before hospitalization. There was also history of personality change and aphasia. Patient was febrile (T = 38.9 ° C). Also patient had symmetric weakness of four extremities. Vancomycin, Cefotaxime and acyclovir were started. Brain CT scan showed midline shift and suspected ischemic lesions. MRI findings include: diffusion restriction was shown diffusely in left parietotemporal lobes and right sylvian gyrus that was not compatible with known arterial territories, early stage transtentorial was seen in left side and 8 mm shift of midline structures toward the right side was present and right mastoiditis was seen. After the second brain CT scan that showed no midline shift, lumbar puncture was done. Cerebrospinal fluid PCR was positive for HSV1. Antibacterial and antiviral treatment continued for a full 21 days. Seizure did not recur and the weakness became completely normal in the second month after discharge with help of physiotherapy exercises. Discussion and conclusion:In our case, there were no focal neurological deficits and the patient experienced loss of consciousness followed by weakness, which is very unusual. It seems that herpes simplex encephalitis can develop as ischemic multifocal lesions and should be considered by physicians. Important in this regard is the strong clinical suspicion and timely initiation of appropriate medication.

Keywords:

HSV1 , encephalitis , ischemic lesions , complications