Brown William D, Bearer Elaine L, Donahue John E
Warren Alpert Medical School at Brown University, Providence, RI, USA.
J Child Neurol. 2010 Jul;25(7):901-8. doi: 10.1177/0883073809353449. Epub 2010 Feb 22.
A unique form of chronic, active, granulomatous herpes simplex type 2 encephalitis is described in an asymptomatic, immunocompetent 8-year-old girl who acquired the virus as a neonate. The extensive, bilateral cerebral parenchymal involvement was discovered incidentally. Diagnosis was confirmed by a combination of serial neuroimaging, brain biopsy, and quantitative polymerase chain reaction targeted to DNA sequences in the glycoprotein G gene, allowing differentiation between herpes simplex virus types 1 and 2. The clinical course over a 5-year period, treatment with intermittent intravenous steroids, and daily valacyclovir, diagnostic imaging, and laboratory studies are reviewed in detail. This form of herpes simplex virus type 2 encephalitis hasn't been described previously and is significant because of its prolonged indolent course, absence of neurological findings or suggestive history, and benign behavior in this child, who is now 14 years old. The authors believe this entity can be unsuspected and underdiagnosed in the general pediatric population, especially in those with a prior maternal history of herpes simplex virus type 2 infection.
一名8岁无症状、免疫功能正常的女童被描述为患有独特形式的慢性、活动性、肉芽肿性2型单纯疱疹病毒性脑炎，她在新生儿期感染了该病毒。广泛的双侧脑实质受累是偶然发现的。通过系列神经影像学检查、脑活检以及针对糖蛋白G基因DNA序列的定量聚合酶链反应相结合来确诊，从而区分1型和2型单纯疱疹病毒。详细回顾了5年期间的临床病程、间歇性静脉注射类固醇和每日服用伐昔洛韦的治疗情况、诊断性影像学检查以及实验室研究。这种形式的2型单纯疱疹病毒性脑炎此前未曾被描述过，其意义在于病程迁延隐匿、无神经系统表现或提示性病史，且该现已14岁的患儿病情表现良性。作者认为，在普通儿科人群中，尤其是有母亲2型单纯疱疹病毒感染史的儿童中，这种病症可能未被怀疑且诊断不足。
