Atypical Presentation of Herpes Simplex Virus 1 Encephalitis in Pediatric Age

Carmen Gulizia; Pierluigi Smilari; Filippo Greco; Alessandra Fontana; Manuela Ceccarelli; Emmanuele Venanzi Rullo; Giuseppe Nunnari; Piero Pavone

doi:10.3889/oamjms.2021.6244

Authors

Carmen Gulizia Department of Clinical and Experimental Medicine, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
Pierluigi Smilari Department of Clinical and Experimental Medicine, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
Filippo Greco Department of Clinical and Experimental Medicine, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
Alessandra Fontana Department of Clinical and Experimental Medicine, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
Manuela Ceccarelli Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, Catania, Italy; Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, Unit of Infectious Diseases, University of Messina, Catania, Catania, Italy https://orcid.org/0000-0001-5987-3576
Emmanuele Venanzi Rullo Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Catania, Italy https://orcid.org/0000-0001-8273-5382
Giuseppe Nunnari Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Catania, Italy https://orcid.org/0000-0001-5987-3576
Piero Pavone Department of Clinical and Experimental Medicine, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy

DOI:

https://doi.org/10.3889/oamjms.2021.6244

Keywords:

Herpes infection, Acute encephalitis, HSV- DNA PCR test, Seizures

Abstract

BACKGROUND: The annual incidence of herpes simplex encephalitis (HSE) is 1:250–500 thousand in developed countries, which makes it the most common viral cause of encephalitis. Encephalitis caused by HSV-1 probably accounts for most of the cases in the Herpesviridae family and typically affects older children.

CASE REPORT: An atypical presentation of pediatric herpetic encephalitis is reported. The child presented with recurrent seizures that were initially unresponsive to several anticonvulsant drugs. EEG and MRI of the brain were not effective for diagnosis. PCR analysis of the cerebrospinal fluid indicated positivity for HSV DNA and was crucial for the diagnosis as a highly sensitive and specific test.

CONCLUSION: Based on the clinical presentation of the child, viral encephalitis was deemed to be the most likely aetiological condition.

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