Chronic meningitis due to herpes simplex virus in an immunocompetent host

Abstract

Herpes simplex virus (HSV) typically causes mucocutaneous disease, encephalitis, and acute men ingitis. There have been no previous reports of chronic meningitis due to this virus. A case of chronic meningitis due to herpes simplex virus type 2 (HSV-2) in a previously healthy 35-year-old woman whose predominant symptoms were headache and meningism without fever is described. Analysis of cerebrospinal fluid (CSF) revealed a lymphocytic pleocytosis, elevated protein, and hypoglycorrhachia. The diagnosis of herpes simplex meningitis was supported by the detection of HSV-2 DNA in CSF by polymerase chain reaction and by intrathecal production of HSV-specific antibody. The patient recovered after treatment with intravenous acyclovir and glucocorticoids.

Increased Detection Rate in Diagnosis of Herpes Simplex Virus Type 2 Meningitis by Real-Time PCR Using Cerebrospinal Fluid Samples

“…Hypoglycorrhachia has previously been reported in HSM (4,7,8,14). In our study, slightly increased lactate levels and lowered CSF/serum glucose ratios were found with a small proportion of HSM patients, in agreement with previous reports.…”

Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance

“…4,5,6,7 Our study supports finding of hypoglycorrachia associated with viral causes such as HSV, VZV and CMV.…”

“…1,2 In order to have a reliable CSF to serum glucose ratio, the time between the two determinations should be done within 60 minutes of each other. 2 Hypoglycorrhachia is usually suggestive of bacterial, tuberculous and fungal meningitis but has been reported in other cases such as in viral/aseptic meningitis 4–7 , leptomeningeal carcinomatosis 8 , subarachnoid hemorrhage 9 , Lyme meningitis 10 , neurobrucellosis 11 , and neurosarcoidosis 12 . The only study to our knowledge that has evaluated the differential diagnosis of hypoglycorrhachia was done in children and published in 1976 before the advent of molecular diagnostic tests 13 .…”

Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections

“…120 Neurologic disorders include longstanding active HSV encephalitis, 121 VZV-related chronic myelitis with chronic unilateral periauricular and facial pain, 122 active chronic VZV infection with chronic radicular sacraldistribution pain, cervical-distribution zoster paresis, and thoracic-distribution myelopathy, 123 chronic VZV ganglionitis-related postherpetic neuralgia, 124 and chronic HSV-2 meningitis. 125 TK-dependent antiviral resistance also frequently complicates extracutaneous HSV and VZV chronic infections.…”