Published online March 1, 2005
PEDIATRICS Vol. 115 No. 3 March 2005, pp. 804-809 (doi:10.1542/peds.2004-0777)

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EXPERIENCE AND REASON

Herpes Simplex Virus Encephalitis During Suppressive Therapy With Acyclovir in a Premature Infant

Monica Fonseca-Aten, MD, Allison F. Messina, MD, Hasan S. Jafri, MD and Pablo J. Sánchez, MD

From the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas

Cutaneous herpes simplex virus type 2 (HSV-2) infection was recognized at 19 days of age in a 1415-g female infant born at 31 weeks of gestation. Cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) was negative, and MRI of the brain was normal. After a 14-day course of high-dose intravenous acyclovir, the infant developed a cutaneous recurrence at 38 days of age. CSF HSV PCR again was negative. She was subsequently begun on oral acyclovir to prevent cutaneous reactivation of HSV. At 3 months of age, the infant developed HSV encephalitis as manifested by fever, seizures, abnormal CSF indices, abnormal brain MRI, and positive CSF HSV PCR. No cutaneous disease was present. It is not known whether the HSV encephalitis in our patient represented reactivation of previously unrecognized central nervous system infection or new onset of central nervous system disease as a result of spread from other tissue or site to the brain. The failure of oral acyclovir to prevent such an occurrence, however, highlights gaps in our understanding of the pathogenesis of neonatal HSV disease and questions the use of acyclovir suppression to prevent neurologic sequelae.

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Key Words: herpes simplex virus • acyclovir • encephalitis • prophylaxis

Abbreviations: HSV, herpes simplex virus • SEM, skin, eye, and mouth • CBC, complete blood cell • WBC, white blood cell • CSF, cerebrospinal fluid • RBC, red blood cell • PCR, polymerase chain reaction • CT, computed tomography • CNS, central nervous system

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Accepted Jul 27, 2004.

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