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© 1987 American Academy of Neurology Acute ascending necrotizing myelopathy caused by herpes simplex virus type 2Departments of Pathology (Neuropathology) (Drs. Wiley, Carpenter, and Powell) and Neuroscience (Drs. VanPatten and Thal), University of California, San Diego, La Job, and the Department of Neurology (Drs. VanPatten and Thal), San Diego Veterans Administration Medical Center, La Job, CA. A 57-year-old diabetic man died of a rapidly ascending necrotizing myelitis. Autopsy results proved that the etiologic agent was herpes simplex virus type 2 (HSV2). The clinical findings, autopsy immunohistopathology, and electron-microscopy suggest that either primary HSV2 infection or reactivation of HSV2 infection within dorsal root ganglia was followed by spread to the spinal cord. Viral infection of the CNS occurred by direct extension and led to death by involvement of the brainstem. Although there is only one previous report of HSV2 myelitis in the literature, our findings suggest that HSV2 might be a more common etiologic agent of necrotizing myelitis. Because CSF cultures are usually negative, viral inclusions are not usually seen, and morphologically identifiable virions are exquisitely rare, previous cases were probably descriptively diagnosed as acute ascending necrotizing myelitis without etiologic identification. Address correspondence and reprint requests to Dr. Wiley, Department of Pathology (M-012). University of California, San Diego, School of Medicine, La Jolla, CA 92093. Supported in part by grants from the National Institutes of Health AG-04342–05, NS00928-03, and NS25178-01. Received November 17, 1986. Accepted for publication in final form January 21, 1987.
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