Third time's a charm: diagnosis of herpes simplex encephalitis after two negative polymerase chain reaction results

Heliyon

Charles R. Rinaldo¹  Pouria Moshayedi²  Ajitesh Ojha³  Mahbobeh Niksefat⁴  Daniel Guillen⁴ 

[1] Corresponding author.;Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;

关键词: Neuroscience;    Nervous system;    Viral disease;    Neurology;    Diagnostics;    Neurovirology;   

DOI  :  

来源: DOAJ

【 摘 要 】

Introduction: Polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) is a sensitive and specific method in diagnosing herpes simplex virus (HSV) encephalitis. However there are increasing reports of false negative HSV PCR. Case description: We present a patient in the 9th decade of life with abnormal behavior and focal seizures with MRI showing a right temporal T2 hyperintense non-enhancing lesion with electrographic evidence of right lateralized periodic discharges. CSF analysis and PCR for HSV-1 and 2 yielded negative results twice, and therefore acyclovir was discontinued. Patient initially improved following correction of hyponatremia. Patient however deteriorated and imaging revealed a new right parietal lesion. Third CSF sample showed lymphocytic pleocytosis with positive HSV-1 PCR. Patient improved following antiviral treatment. Discussion: Acyclovir treatment should continue in high clinical suspicion scenarios despite negative HSV PCR. We further discuss causes of PCR false negatives and challenges it poses for patient care.

【 授权许可】

Unknown