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Washington University Experience | INFECTION | Viruses | Herpes Simplex type I (HSV-1) | HSV-I Encephalitis, Residua | 3A0 Case 3 History
Case 3 History ---- The patient was a 14 day old female born at 27 weeks of gestational age. She had multiple areas of macerated skin with weeping desquamation, marked cyanosis, and generalized hypotonia. Cranial ultrasound examinations showed multiple germinal matrix hemorrhages within the day of birth and afterward, ventriculomegaly (right>left) and a right choroid plexus hemorrhage. The patient was found to have numerous other problems including acidosis, respiratory failure, renal failure, a patent ductus arteriosus that did not close in response to Indocin, sepsis with DIC, hypotension, thrombocytopenia and multiple electrolyte abnormalities. Additional hemorrhage was noted within the thalami bilaterally as well as in the right caudate nuclei. Finally there was also posterior fossa-cerebellar intraparenchymal hemorrhage. IV acyclovir was started before samples of skin, eye, rectum and mouth demonstrated HSV-1 by PCR. Tests for varicella/zoster, toxoplasmosis, RPR and CMV were negative. The patient was diagnosed with disseminated congenital HSV-1 (not HSV-II) infection and died shortly after withdrawal of life support given her very grim prognosis.
