Shimada Tomoyo, Tsunemi Taiji, Iimura Yasushi, Sugano Hidenori, Hattori Nobutaka
Department of Neurology, Juntendo University School of Medicine.
Epilepsy Center, Juntendo University School of Medicine.
Rinsho Shinkeigaku. 2022 Sep 28;62(9):697-706. doi: 10.5692/clinicalneurol.cn-001734. Epub 2022 Aug 26.
After establishing latent infection, some viruses can be reactivated by the alteration of host immunological conditions. First, we reviewed viruses that can cause neuronal damage by reactivation. Then we focused on the herpes simplex virus (HSV). The reactivation leads to neuronal damages through two possible mechanisms; "reactivation of a latent herpes virus" by which viruses can cause direct virus neurotoxicity, and "post-infectious immune inflammatory response" by which a focal reactivation of HSV leads to an inflammatory reaction. The former is radiologically characterized by cortical lesions, the latter is characterized by subcortical white matter lesions. We experienced a female, who underwent the right posterior quadrantectomy and then developed recurrent herpes encephalitis caused by herpes simplex reactivation, which pathologically demonstrated inflammation in the white matter, suggesting a post-infectious immune inflammatory response. The patient was successfully treated with immunosuppressants. The reactivation of the HSV is extremely rare in Japan. Neurologists should recognize this condition because this disorder will increase as epilepsy surgery gains more popularity.
在建立潜伏感染后，一些病毒可因宿主免疫状况的改变而重新激活。首先，我们回顾了可通过重新激活导致神经元损伤的病毒。然后我们聚焦于单纯疱疹病毒（HSV）。重新激活可通过两种可能机制导致神经元损伤；一是“潜伏疱疹病毒的重新激活”，病毒借此可引起直接的病毒神经毒性，二是“感染后免疫炎症反应”，HSV的局灶性重新激活导致炎症反应。前者在放射学上以皮质病变为特征，后者以皮质下白质病变为特征。我们接诊了一名女性患者，她接受了右后象限切除术，随后因单纯疱疹病毒重新激活而发生复发性疱疹性脑炎，病理显示白质炎症，提示为感染后免疫炎症反应。该患者通过免疫抑制剂治疗成功治愈。HSV的重新激活在日本极为罕见。神经科医生应认识到这种情况，因为随着癫痫手术越来越普及，这种疾病将会增多。
