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Recurrent brainstem encephalitis associated with herpes simplex virus type 1 DNA in cerebrospinal fluid

From the Departments of Neurology (Dr. Tyler), Medicine (Infectious Disease) (Drs. Tyler and Levin), Microbiology and Immunology (Dr. Tyler), and Pediatrics (Infectious Diseases Section) (Drs. Tedder and Levin), University of Colorado Health Sciences Center, Denver, CO; the Department of Neurology (Dr. Tyler), Denver VA Medical Center, The Children's Hospital (Drs. Tedder and Levin), and Saint Joseph Hospital (Drs. Yamamoto and Klapper), Denver, CO; the Department of Laboratory Medicine (Dr. Ashley), Children's Hospital, University of Washington, Seattle, WA; and Rose Medical Center (Dr. Lichtenstein), Denver, CO.
Supported by a Merit grant from the Department of Veterans Affairs (K.L.T.), an NINDS Program Project Grant to the Neurologic AIDS Research Consortium (1PO:NS32280) (K.L.T.), and by the Louis and Sydell Bruckner Memorial Fund of the University of Colorado School of Medicine (M.J.L.).
Received February 3, 1995. Accepted in final form March 29, 1995.
Address correspondence and reprint requests to Dr Tyler, Department of Neurology #127, Denver VA Medical Center, 1055 Clermont Street, Denver, CO 80220.

A 47-year-old man had recurrent signs and symptoms of brainstem encephalitis over a 4-year period. Although CSF viral cultures were repeatedly negative, herpes simplex virus type 1 (HSV-1) DNA was detected in CSF by polymerase chain reaction (PCR). HSV-1-specific antibodies were absent at the time of the first positive PCR test, but CSF seroconversion to high HSV-1-specific antibody titer subsequently occurred. CSF antibody to cytomegalovirus (CMV) and varicella-zoster virus (VZV) was not detectable, nor could CMV, VZV, or Epstein-Barr virus nucleic acid be detected in CSF by PCR. This is the first report of the use of CSF PCR for the rapid antemortem diagnosis of herpetic brainstem encephalitis.

NEUROLOGY 1995;45: 2246-2250

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