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2020-02-18Zeitschriftenartikel DOI: 10.25646/6577
Travel-associated neurological disease terminated in a postmortem diagnosed atypical HSV-1 encephalitis after high-dose steroid therapy – a case report
dc.contributor.authorOsterman, Andreas
dc.contributor.authorRuf, Viktoria C.
dc.contributor.authorDomingo, Christina
dc.contributor.authorNitsche, Andreas
dc.contributor.authorEichhorn, Peter
dc.contributor.authorZimmermann, Hanna
dc.contributor.authorSeelos, Klaus
dc.contributor.authorZange, Sabine
dc.contributor.authorDimitriadis, Konstantinos
dc.contributor.authorPfister, Hans-Walter
dc.contributor.authorThye, Thorsten
dc.contributor.authorGiese, Armin
dc.contributor.authorTappe, Dennis
dc.contributor.authorBöhm, Stephan
dc.date.accessioned2020-03-23T06:59:48Z
dc.date.available2020-03-23T06:59:48Z
dc.date.issued2020-02-18none
dc.identifier.other10.1186/s12879-020-4859-5
dc.identifier.urihttp://edoc.rki.de/176904/6544
dc.description.abstractBackground Human encephalitis can originate from a variety of different aetiologies, of which infection is the most common one. The diagnostic work-up is specifically challenging in patients with travel history since a broader spectrum of unfamiliar additional infectious agents, e. g. tropical disease pathogens, needs to be considered. Here we present a case of encephalitis of unclear aetiology in a female traveller returning from Africa, who in addition developed an atypical herpes simplex virus (HSV) encephalitis in close temporal relation with high-dose steroid treatment. Case presentation A previously healthy 48-year-old female presented with confusion syndrome and impaired vigilance which had developed during a six-day trip to The Gambia. The condition rapidly worsened to a comatose state. Extensive search for infectious agents including a variety of tropical disease pathogens was unsuccessful. As encephalitic signs persisted despite of calculated antimicrobial and antiviral therapy, high-dose corticosteroids were applied intravenously based on the working diagnosis of an autoimmune encephalitis. The treatment did, however, not improve the patient’s condition. Four days later, bihemispheric signal amplification in the insular and frontobasal cortex was observed on magnetic resonance imaging (MRI). The intracranial pressure rapidly increased and could not be controlled by conservative treatment. The patient died due to tonsillar herniation 21 days after onset of symptoms. Histological examination of postmortem brain tissue demonstrated a generalized lymphocytic meningoencephalitis. Immunohistochemical reactions against HSV-1/2 indicated an atypical manifestation of herpesviral encephalitis in brain tissue. Moreover, HSV-1 DNA was detected by a next-generation sequencing (NGS) metagenomics approach. Retrospective analysis of cerebrospinal fluid (CSF) and serum samples revealed HSV-1 DNA only in specimens one day ante mortem. Conclusions This case shows that standard high-dose steroid therapy can contribute to or possibly even trigger fulminant cerebral HSV reactivation in a critically ill patient. Thus, even if extensive laboratory diagnostics including wide-ranging search for infectious pathogens has been performed before and remained without results, continuous re-evaluation of potential differential diagnoses especially regarding opportunistic infections or reactivation of latent infections is of utmost importance, particularly if new symptoms occur.eng
dc.language.isoengnone
dc.publisherRobert Koch-Institut
dc.rights(CC BY 3.0 DE) Namensnennung 3.0 Deutschlandger
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/de/
dc.subjectHerpes simplex viruseng
dc.subjectNext generation sequencingeng
dc.subjectEncephalitiseng
dc.subjectSteroideng
dc.subjectThe Gambiaeng
dc.subjectTravel associatedeng
dc.subjectYellow fever vaccine associated neurological diseaseeng
dc.subject.ddc610 Medizin und Gesundheitnone
dc.titleTravel-associated neurological disease terminated in a postmortem diagnosed atypical HSV-1 encephalitis after high-dose steroid therapy – a case reportnone
dc.typearticle
dc.identifier.urnurn:nbn:de:kobv:0257-176904/6544-3
dc.identifier.doihttp://dx.doi.org/10.25646/6577
dc.type.versionpublishedVersionnone
local.edoc.container-titleBMC Infectious Diseasesnone
local.edoc.type-nameZeitschriftenartikel
local.edoc.container-typeperiodical
local.edoc.container-type-nameZeitschrift
local.edoc.container-urlhttps://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-4859-5none
local.edoc.container-publisher-nameBioMed Centralnone
local.edoc.container-volume20none
local.edoc.container-issue150none
local.edoc.container-year2020none
local.edoc.container-firstpage1none
local.edoc.container-lastpage9none
local.edoc.rki-departmentZentrum für Biologische Gefahren und Spezielle Pathogenenone
dc.description.versionPeer Reviewednone

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