Clinical case of of lumbar-sacral myelitis HSV2-etiology in a patient with a selective deficiency of natural killers

Abstract

In this article deals with a typical clinical example of a severe form of acute neuroinfectious lesion of the spinal cord HSV2‑etiology in a patient with minor cellular immunodeficiency, who suffered from often recurrent genital herpes without adequate prophylactic antiviral treatment for the prevention of CNS damage. The patient, M., 54 years old, had acute lumbosacral myelitis, caused by herpes virus type 2, with a picture of the lower deep paraparesis, paragypesthesia, impaired pelvic organs functions. The diagnosis is confirmed on the basis of a PCR of the cerebrospinal fluid. Immunological examination revealed a selective deficiency of natural killers (CD3–CD1+CD56+ lymphocytes) — cells that are important in controlling the latent virus in the sacral sensory ganglia. A genetic survey identified a deficiency of the folate cycle that caused the minor cellular immune deficiency (MTHFR 677 С > Т homo, MTHFR 1298 А > С hetero, MTRR 66 A > G hetero). Therefore, the patient received dual treatment — acyclic analogues of guanosine to suppress viral reproduction and interferone therapy to compensate cellular immunodeficiency. This case demonstrates the feasibility of close interaction between neurologists and clinical immunologists in immunocompromised patients with neuroinfectional lesions caused by opportunistic pathogens.