Herpes Simplex Virus Type-1 Meningoencephalitis Showing Disseminated Cortical Lesions

Abstract

We report a 41-year-old man with meningoencephalitis associated with herpes simplex virus type 1 (HSV-1). The patient developed fever, headache and dysuria followed by generalized convulsion and neck stiffness, and the CSF showed pleocytosis. The titers of enzyme-linked immunosorbent assay against HSV measured 6 days after onset showed a significant rise; IgG antibody 4.89 (<0.2) and IgM antibody 1.45 (<0.8) in CSF, IgG antibody 46.1 (<2.0) and IgM antibody 1.76 (<0.8) in the serum. The antibody index for IgG was 0.50, and that for IgM was 4.2. CFS neutralization test showed HSV-1 antibody of ×16 and HSV-2 antibody of <×4. MRI showed atypical features: disseminated cortical lesions without massive hemispheric involvement. All of the cortical lesions were small and appeared to be located in the gray matter. The patient recovered with acyclovir. This report demonstrates that disseminated encephalitis can be a feature of acute HSV-1 infection.