Giulia Berzero1, Anna Luisa Di Stefano2, Caroline Dehais3, Marc Sanson3, Paola Gaviani4, Antonio Silvani4, Andrea Salmaggi5, Paolo Vitali6, Luca Diamanti1, Fausto Baldanti7, Lisa Maria Farina6, Mauro Ceroni8, Enrico Marchioni6. 1. C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Pavia, Italy. 2. C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris, France. 3. AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris, France. 4. Neuro-oncology Unit, C. Besta Neurological Institute, Milan, Italy. 5. Neuro-oncology Unit, C. Besta Neurological Institute, Milan, Italy SC Neurologia, Ospedale A. Manzoni, Lecco, Italy. 6. C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy. 7. Molecular Virology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. 8. C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy Department of Neuroscience, University of Pavia, Pavia, Italy.
Abstract
OBJECTIVES: In recent years, herpes simplex encephalitis (HSE) has been reported with increasing frequency in settings of immunosuppression, such as acquired immunodeficiency, transplantation and cancer. As observed, in immunocompromised individuals HSE presents peculiar clinical and paraclinical features, and poorer prognosis. METHODS: Here we describe a retrospective series of seven cases of HSE in patients with high-grade glioma (HGG), collected among three institutions in a 5-year period (during this time, a total of 1750 patients with HGG were treated). RESULTS: Diagnosis of the condition was particularly challenging due to the confounding clinical presentation and the atypical biological findings. As a result, antiviral treatment was started with a sharp delay compared with immunocompetent hosts. Prognosis was poor, with high short-term mortality and severe residual disability in survivors. CONCLUSIONS: The substantial incidence of HSE observed in our centres together with the difficulty in diagnosing the condition suggest that the incidence of this complication may be highly underestimated. The aim of our report is to strengthen the observation of HSE in patients with HGG and outline the key elements that may allow its diagnosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVES: In recent years, herpes simplex encephalitis (HSE) has been reported with increasing frequency in settings of immunosuppression, such as acquired immunodeficiency, transplantation and cancer. As observed, in immunocompromised individuals HSE presents peculiar clinical and paraclinical features, and poorer prognosis. METHODS: Here we describe a retrospective series of seven cases of HSE in patients with high-grade glioma (HGG), collected among three institutions in a 5-year period (during this time, a total of 1750 patients with HGG were treated). RESULTS: Diagnosis of the condition was particularly challenging due to the confounding clinical presentation and the atypical biological findings. As a result, antiviral treatment was started with a sharp delay compared with immunocompetent hosts. Prognosis was poor, with high short-term mortality and severe residual disability in survivors. CONCLUSIONS: The substantial incidence of HSE observed in our centres together with the difficulty in diagnosing the condition suggest that the incidence of this complication may be highly underestimated. The aim of our report is to strengthen the observation of HSE in patients with HGG and outline the key elements that may allow its diagnosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.