Department of Neuroscience and Cervical-Facial Pathology, Neurology, National Cancer Institute Regina Elena, Via Elio Chianesi 53, 00144, Rome, Italy.
J Neurooncol. 2010 Oct;100(1):137-40. doi: 10.1007/s11060-010-0134-8. Epub 2010 Feb 11.
Herpes simplex encephalitis (HSE) is a life-threatening condition with high mortality. The pathogenesis underlying the reactivation of latent herpes simplex virus (HSV) remains undefined. We present the case of a 55-year-old female who developed HSE type 1 during brain irradiation and antioedematous dexamethasone treatment for leptomeningeal metastasized breast tumor with epileptic seizures. During the radiotherapy (RT), after a total of 32 Gray administrated in 16 fractions, our patient developed cognitive impairment and partial epileptic status without fever. Two days later the patient's clinical conditions had deteriorated and high fever manifested. A diagnosis of HSE type 1 was made by a positive cerebrospinal fluid polymerase chain reaction. Antiviral therapy with high doses of acyclovir was practiced for four weeks but the comatose state persisted. The patient died 59 days after the last RT fraction. The temporal relationship of RT to the occurrence of HSE suggests that cranial irradiation may play a role in the reactivation of latent HSV. Although antiviral therapy resistance is infrequent in immunocompetent patients, it is one of the main problems in immunocompromized patients.
单纯疱疹病毒性脑炎（HSE）是一种危及生命的疾病，死亡率很高。潜伏的单纯疱疹病毒（HSV）重新激活的发病机制尚不清楚。我们报告了一例 55 岁女性的病例，她在脑放疗和抗水肿地塞米松治疗脑膜转移的乳腺癌时出现 1 型单纯疱疹病毒性脑炎，同时伴有癫痫发作。在放疗（RT）期间，患者共接受了 16 次分割的 32 Gray 照射后，出现认知障碍和部分癫痫状态，无发热。两天后，患者的临床状况恶化，出现高热。通过脑脊液聚合酶链反应阳性诊断为 1 型单纯疱疹病毒性脑炎。患者接受了高剂量阿昔洛韦抗病毒治疗 4 周，但仍处于昏迷状态。患者在最后一次 RT 后 59 天死亡。RT 与 HSE 发生的时间关系提示，颅照射可能在潜伏 HSV 的重新激活中起作用。尽管抗病毒治疗耐药在免疫功能正常的患者中并不常见，但在免疫功能低下的患者中是一个主要问题。
