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Chronic granulomatous herpes encephalitis in a child with clinically intractable epilepsy.

Hackney JR, Harrison DK, Rozzelle C, Kankirawatana S, Kankirawatana P, Palmer CA - Case Rep Pediatr (2012)

Bottom Line: His history was significant for herpes meningitis at age 4 months.Immunohistochemistry for herpes simplex virus showed focal immunoreactivity.This rare form of herpes encephalitis has only been reported in children, but the initial presentation of meningitis and the approximate 10-year-time interval in this case are unusual.

View Article: PubMed Central - PubMed

Affiliation: Division of Neuropathology, Department of Pathology, University of Alabama at Birmingham, 1960 6th Avenue South, PD6A 175E, Birmingham, AL 35294, USA.

ABSTRACT
Most patients with herpes simplex virus Type I encephalitis experience an acute, monophasic illness. Chronic encephalitis is much less common, and few late relapses are associated with intractable seizure disorders. A 10-year-old boy was admitted to our institution for intractable epilepsy as part of an evaluation for epilepsy surgery. His history was significant for herpes meningitis at age 4 months. At that time, he presented to an outside hospital with fever for three days, with acyclovir treatment beginning on day 4 of his 40-day hospital course. He later developed infantile spasms and ultimately a mixed seizure disorder. Video electroencephalogram showed a Lennox-Gastaut-type pattern with frequent right frontotemporal spikes. Imaging studies showed an abnormality in the right frontal operculum. Based on these findings, he underwent a right frontal lobectomy. Neuropathology demonstrated chronic granulomatous inflammation with focal necrosis and mineralizations. Scattered lymphocytes, microglial nodules and nonnecrotizing granulomas were present with multinucleated giant cells. Immunohistochemistry for herpes simplex virus showed focal immunoreactivity. After undergoing acyclovir therapy, he returned to baseline with decreased seizure frequency. This rare form of herpes encephalitis has only been reported in children, but the initial presentation of meningitis and the approximate 10-year-time interval in this case are unusual.

No MeSH data available.


Related in: MedlinePlus

Histopathologic sections reveal chronic inflammation, astrogliosis, and scattered mineralizations [(a) H&E ×200]. Frequent multinucleated giant cells were present [(b): H&E ×400].
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fig2: Histopathologic sections reveal chronic inflammation, astrogliosis, and scattered mineralizations [(a) H&E ×200]. Frequent multinucleated giant cells were present [(b): H&E ×400].

Mentions: Neuropathological examination of the right frontal lesion demonstrated chronic granulomatous inflammation with foci of necrosis and mineralization. Scattered clusters of lymphocytes, microglial nodules, and small, discrete nonnecrotizing granulomas were present with occasional multinucleated giant cells (Figure 2). Some giant cells had mineralized material within the cytoplasm. These changes were set within both gliotic cerebral cortex and superficial white matter. Immunohistochemical staining for herpes simplex virus (HSV I/II, Cell Marque, Rocklin, California) demonstrated focal nuclear and cytoplasmic immunoreactivity within scattered neuronal and glial cells (Figure 3). The specificity of this tissue marker is such that cross reactivity may be seen with varicella-zoster virus at high concentrations, but cross-reactivity with cytomegalovirus or Epstein-Barr virus is not seen. Special staining for fungi and immunohistochemical staining for cytomegalovirus were also performed and both were negative.


Chronic granulomatous herpes encephalitis in a child with clinically intractable epilepsy.

Hackney JR, Harrison DK, Rozzelle C, Kankirawatana S, Kankirawatana P, Palmer CA - Case Rep Pediatr (2012)

Histopathologic sections reveal chronic inflammation, astrogliosis, and scattered mineralizations [(a) H&E ×200]. Frequent multinucleated giant cells were present [(b): H&E ×400].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3420097&req=5

fig2: Histopathologic sections reveal chronic inflammation, astrogliosis, and scattered mineralizations [(a) H&E ×200]. Frequent multinucleated giant cells were present [(b): H&E ×400].
Mentions: Neuropathological examination of the right frontal lesion demonstrated chronic granulomatous inflammation with foci of necrosis and mineralization. Scattered clusters of lymphocytes, microglial nodules, and small, discrete nonnecrotizing granulomas were present with occasional multinucleated giant cells (Figure 2). Some giant cells had mineralized material within the cytoplasm. These changes were set within both gliotic cerebral cortex and superficial white matter. Immunohistochemical staining for herpes simplex virus (HSV I/II, Cell Marque, Rocklin, California) demonstrated focal nuclear and cytoplasmic immunoreactivity within scattered neuronal and glial cells (Figure 3). The specificity of this tissue marker is such that cross reactivity may be seen with varicella-zoster virus at high concentrations, but cross-reactivity with cytomegalovirus or Epstein-Barr virus is not seen. Special staining for fungi and immunohistochemical staining for cytomegalovirus were also performed and both were negative.

Bottom Line: His history was significant for herpes meningitis at age 4 months.Immunohistochemistry for herpes simplex virus showed focal immunoreactivity.This rare form of herpes encephalitis has only been reported in children, but the initial presentation of meningitis and the approximate 10-year-time interval in this case are unusual.

View Article: PubMed Central - PubMed

Affiliation: Division of Neuropathology, Department of Pathology, University of Alabama at Birmingham, 1960 6th Avenue South, PD6A 175E, Birmingham, AL 35294, USA.

ABSTRACT
Most patients with herpes simplex virus Type I encephalitis experience an acute, monophasic illness. Chronic encephalitis is much less common, and few late relapses are associated with intractable seizure disorders. A 10-year-old boy was admitted to our institution for intractable epilepsy as part of an evaluation for epilepsy surgery. His history was significant for herpes meningitis at age 4 months. At that time, he presented to an outside hospital with fever for three days, with acyclovir treatment beginning on day 4 of his 40-day hospital course. He later developed infantile spasms and ultimately a mixed seizure disorder. Video electroencephalogram showed a Lennox-Gastaut-type pattern with frequent right frontotemporal spikes. Imaging studies showed an abnormality in the right frontal operculum. Based on these findings, he underwent a right frontal lobectomy. Neuropathology demonstrated chronic granulomatous inflammation with focal necrosis and mineralizations. Scattered lymphocytes, microglial nodules and nonnecrotizing granulomas were present with multinucleated giant cells. Immunohistochemistry for herpes simplex virus showed focal immunoreactivity. After undergoing acyclovir therapy, he returned to baseline with decreased seizure frequency. This rare form of herpes encephalitis has only been reported in children, but the initial presentation of meningitis and the approximate 10-year-time interval in this case are unusual.

No MeSH data available.


Related in: MedlinePlus