Herpes simplex (HSV-1) aseptic meningitis

Abstract

Herpes simplex virus type 1 (HSV-1) most frequently presents as mucocutaneous lesions. HSV-1 is common worldwide, and has a seroprevalence of as many as 80% in parts of the United States. 1 Whitley R.J Herpes simplex viruses. in: Knipe D.M Howley P.M Griffin D.E Fields' Virology, 4th ed. Lippincott Williams and Wilkins, Philadelphia2001: 2461-2498 Google Scholar HSV-1 also is the most common cause of viral encephalitis. 2 Whitley J.R Kimberlin D.W Viral encephalitis. Pediatr Rev. 1999; 20: 192-197 Crossref PubMed Scopus (32) Google Scholar Less frequently, HSV-1 can also cause meningoencephalitis and uncommonly, aseptic meningitis presents with headache, nuchal rigidity, vomiting, and photophobia. 2 Whitley J.R Kimberlin D.W Viral encephalitis. Pediatr Rev. 1999; 20: 192-197 Crossref PubMed Scopus (32) Google Scholar , 3 Corey L Herpes simplex virus. in: Mandell G.L Bennett J.E Dolin R Principles and Practice of Infectious Disease. 5th ed. Churchill Livingston, New York2000: 1564-1575 Google Scholar , 4 Simko J.P Caliendo A.M Hogle K Versalovic J Differences in laboratory findings for cerebrospinal fluid specimens obtained from patients with meningitis or encephalitis due to herpes simplex virus (HSV) documented by detection of HSV DNA. Clin Infect Dis. 2002; 35: 414-419 Crossref PubMed Scopus (45) Google Scholar Patients with HSV-1 encephalitis usually present with fever, headache, seizures and mental confusion. 2 Whitley J.R Kimberlin D.W Viral encephalitis. Pediatr Rev. 1999; 20: 192-197 Crossref PubMed Scopus (32) Google Scholar In patients without encephalitis, HSV-1 is often not considered in the differential diagnosis of aseptic meningitis. In cerebral spinal fluid (CSF) of patients with HSV-1 encephalitis, findings include mononuclear predominance of cells, a variably elevated protein, a normal glucose and red blood cells (RBCs). 5 Thomson Jr, R.B Bertram H Laboratory diagnosis of central nervous system infections. Infect Dis Clin North Am. 2001; 15: 1047-1071 Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar , 6 Zunt J.R Marra C Cerebrospinal fluid testing for the diagnosis of central nervous system infections. Neurol Clin. 1999; 17: 75-82 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Aseptic meningitis caused by HSV-1 is more likely to demonstrate higher CSF white blood cell counts and protein, and there are no CSF RBCs. For this reason, HSV-1 is not often considered in the differential diagnosis of aseptic meningitis. This illustrative case is a patient with HSV-1 aseptic meningitis diagnosed by CSF polymerase chain reaction (PCR).