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An adolescent with herpes simplex encephalitis, presenting with mild symptoms and rapid deterioration: A case report

Headaches in children are a common, but unspecific symptom that can have many underlying causes, ranging from unspecific tension headache through migraine and up to encephalitis and intracranial hypertension. We present the case of a 14-year-old boy who presented to our emergency department with hea...

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Autores principales: Stepien, Natalia, Weseslindtner, Lukas, Seidl, Rainer, Geldner, Julia, Golej, Johann, Schmook, Maria-Theresa, Peyrl, Andreas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724412/
https://www.ncbi.nlm.nih.gov/pubmed/33335735
http://dx.doi.org/10.1177/2050313X20977142
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author Stepien, Natalia
Weseslindtner, Lukas
Seidl, Rainer
Geldner, Julia
Golej, Johann
Schmook, Maria-Theresa
Peyrl, Andreas
author_facet Stepien, Natalia
Weseslindtner, Lukas
Seidl, Rainer
Geldner, Julia
Golej, Johann
Schmook, Maria-Theresa
Peyrl, Andreas
author_sort Stepien, Natalia
collection PubMed
description Headaches in children are a common, but unspecific symptom that can have many underlying causes, ranging from unspecific tension headache through migraine and up to encephalitis and intracranial hypertension. We present the case of a 14-year-old boy who presented to our emergency department with headache, nausea as well as vomiting and developed seizures later on. The initial diagnosis was complicated by a magnetic resonance imaging which did not show any signs of inflammation, but was of limited informative value due to orthodontic appliances. Despite the unremarkable imaging, prophylactic antiviral and antibiotic treatment was started after lumbar puncture. Herpes simplex virus as well as human herpes virus 7 were confirmed in the cerebrospinal fluid. Although both viruses are ubiquitous, severe infections are a rare complication. Immunodeficiency syndromes are predisposing factors for serious complications and genetic analysis of UNC93B and TLR-3 might be helpful for decision-making. No genetic or immunologic predisposition was found in our patient. The patient’s condition deteriorated rapidly, so he had to be admitted to the pediatric intensive care unit, where he was intubated and his antiviral treatment with acyclovir was extended by foscarnet. After prolonged mechanical ventilation, he slowly improved. With intensive neurorehabilitation, he could finally return to his daily life activities 3 months after diagnosis. Despite headaches being an unspecific symptom, the possibility of a herpes simplex virus encephalitis should always kept in mind, especially in patients presenting with additional symptoms such as vomiting, altered mental status and/or focal neurological deficits. An initial magnetic resonance imaging might be misleading if orthodontic appliances are in place. Initiation of treatment without delay is crucial for neurologic outcome of herpes simplex virus encephalitis.
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spelling pubmed-77244122020-12-16 An adolescent with herpes simplex encephalitis, presenting with mild symptoms and rapid deterioration: A case report Stepien, Natalia Weseslindtner, Lukas Seidl, Rainer Geldner, Julia Golej, Johann Schmook, Maria-Theresa Peyrl, Andreas SAGE Open Med Case Rep Case Report Headaches in children are a common, but unspecific symptom that can have many underlying causes, ranging from unspecific tension headache through migraine and up to encephalitis and intracranial hypertension. We present the case of a 14-year-old boy who presented to our emergency department with headache, nausea as well as vomiting and developed seizures later on. The initial diagnosis was complicated by a magnetic resonance imaging which did not show any signs of inflammation, but was of limited informative value due to orthodontic appliances. Despite the unremarkable imaging, prophylactic antiviral and antibiotic treatment was started after lumbar puncture. Herpes simplex virus as well as human herpes virus 7 were confirmed in the cerebrospinal fluid. Although both viruses are ubiquitous, severe infections are a rare complication. Immunodeficiency syndromes are predisposing factors for serious complications and genetic analysis of UNC93B and TLR-3 might be helpful for decision-making. No genetic or immunologic predisposition was found in our patient. The patient’s condition deteriorated rapidly, so he had to be admitted to the pediatric intensive care unit, where he was intubated and his antiviral treatment with acyclovir was extended by foscarnet. After prolonged mechanical ventilation, he slowly improved. With intensive neurorehabilitation, he could finally return to his daily life activities 3 months after diagnosis. Despite headaches being an unspecific symptom, the possibility of a herpes simplex virus encephalitis should always kept in mind, especially in patients presenting with additional symptoms such as vomiting, altered mental status and/or focal neurological deficits. An initial magnetic resonance imaging might be misleading if orthodontic appliances are in place. Initiation of treatment without delay is crucial for neurologic outcome of herpes simplex virus encephalitis. SAGE Publications 2020-12-06 /pmc/articles/PMC7724412/ /pubmed/33335735 http://dx.doi.org/10.1177/2050313X20977142 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Case Report
Stepien, Natalia
Weseslindtner, Lukas
Seidl, Rainer
Geldner, Julia
Golej, Johann
Schmook, Maria-Theresa
Peyrl, Andreas
An adolescent with herpes simplex encephalitis, presenting with mild symptoms and rapid deterioration: A case report
title An adolescent with herpes simplex encephalitis, presenting with mild symptoms and rapid deterioration: A case report
title_full An adolescent with herpes simplex encephalitis, presenting with mild symptoms and rapid deterioration: A case report
title_fullStr An adolescent with herpes simplex encephalitis, presenting with mild symptoms and rapid deterioration: A case report
title_full_unstemmed An adolescent with herpes simplex encephalitis, presenting with mild symptoms and rapid deterioration: A case report
title_short An adolescent with herpes simplex encephalitis, presenting with mild symptoms and rapid deterioration: A case report
title_sort adolescent with herpes simplex encephalitis, presenting with mild symptoms and rapid deterioration: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724412/
https://www.ncbi.nlm.nih.gov/pubmed/33335735
http://dx.doi.org/10.1177/2050313X20977142
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