Acute hemorrhagic leukoencephalitis mimicking herpes simplex encephalitis: case report

Abstract

Acute hemorrhagic leukoencephalitis (AHLE) is a more severe form of acute disseminated encephalomyelities (ADEM) characterized by a fulminant clinical course and the presence of hemorrhagic necrosis of the white matter. We report the case of a 57-year-old woman who developed delirium following a respiratory infection. Magnetic resonance imaging of the brain disclosed signal abnormalities in the frontal and temporal lobes, usually found in herpes simplex encephalitis (HSE). Gram stain, India ink and acid-fast bacilli staining were all negative in CSF as was a polymerase chain reaction (PCR) for herpes simplex virus. A diagnosis of AHLE was made and the patient was treated with IV methylprednisolone 1g/day for 5 days. Despite treatment, the patient developed several neurological sequelae compatible with the severity of her illness.

Postpartum Lady with Bleed in the Brain: A Rare Manifestation of Neuroleptospirosis with Acute Haemorrhagic Leucoencephalitis (AHLE)

“…It has been proposed that presence of immune cross-reactivity between myelin basic protein moieties and various infectious agent antigens causing the demyelination. Two prior case reports by Befort and Francisci [3,4] presented two cases of AHLE after Epstein-Barr virus infection.…”

Fulminant intravascular lymphomatosis mimicking acute haemorrhagic leukoencephalopathy

“…Neuroimaging findings in patients with IVL are highly variable, ranging from diffuse involvement of the deep white matter, mimicking acute disseminated encephalomyelitis (with or without contrast enhancement), to infarct-like lesions [2,3,6,[9][10][11][12][13]17]. The patient presented here developed neuroimaging signs which were interpreted as consistent with AHLE [12,13,17].…”

“…Areas of non-gadolinium enhancing restricted diffusion were also seen, as well as a focal area of gadolinium enhancement in the left temporal subcortical white matter. A presumptive diagnosis was made of acute haemorrhagic leukoencephalopathy [13]. Antibodies for HIV and neurotropic viruses in the serum were negative.…”

Acute disseminated encephalomyelitis with medial temporal lesions mimicking acute limbic encephalitis

“…However, urinary retention was common in ADEM [11]. Concerning the limbic lesions, only one case of acute hemorrhagic leukoencephalitis, a more severe form of ADEM, has been reported to have features mimicking herpetic encephalitis [12]. Although multifocal white matter lesions are found in ADEM patients, several ADEM patients have been reported with cerebral cortical lesions [1,[3][4][5][6], suggesting that medial temporal lobes could be affected in patients with ADEM.…”