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MELAS syndrome masquerading as herpes simplex encephalitis

Department of Neurology (Drs. Johns, Stein, and Wityk), Johns Hopkins University School of Medicine, Baltimore, MD; and the Department of Medicine (Dr. Wityk), Division of Neurology, Sinai Hospital of Baltimore, Baltimore, MD.

Herpes simplex encephalitis (HSE) is commonly treated empirically with acyclovir without confirmatory brain biopsy. Three consecutive adults with molecularly verified mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome presented with, and were treated for, apparent HSE. MELAS syndrome in adults may present as an atypical, recurrent form of HSE and should be added to the list of neurologic diseases that can mimic HSE.

Address correspondence and reprint requests to Dr. Donald R. Johns, Harvard Medical School, Building B1-152, 220 Longwood Avenue, Boston, MA 02115.

Supported by NIH Grant NS 01359 and a grant-in-aid from the American Heart Association, Maryland Affiliate, Inc. Dr. Johns is the recipient of a Clinical Investigator Development Award from the National Institute of Neurological Disorders and Stroke.

Received March 4, 1993. Accepted for publication in final form May 7, 1993.

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