Herpes simplex virus 2 vasculitis as cause of ischemic stroke in a young immunocompromised patient
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CASE REPORT
Herpes simplex virus 2 vasculitis as cause of ischemic stroke in a young immunocompromised patient Miguel Leal Rato 1,2 Patrícia Canhão 1,2
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& Beatriz Nunes Vicente & Maria Ribeiro da Cunha & Tiago Marques & Diana Aguiar de Sousa
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Received: 19 May 2020 / Revised: 13 July 2020 / Accepted: 14 August 2020 # Journal of NeuroVirology, Inc. 2020
Abstract Herpes simplex virus 2 (HSV-2) is a very rare cause of central nervous system (CNS) infections. We report a case of a young woman with a left middle cerebral artery (MCA) ischemic stroke. The patient had history of HIV-1 infection, with periods of therapeutic non-compliance. Initial computed tomography (CT) imaging studies showed stenosis of the M1 segment of the left MCA, and magnetic resonance imaging (MRI) confirmed infarction of the MCA territory. Serial transcranial Doppler ultrasound revealed progressive occlusion of the MCA and stenosis of the left anterior cerebral artery. Systemic investigation for other causes of stroke was normal. Lumbar puncture revealed a mildly inflammatory cerebrospinal fluid, and HSV-2 DNA was identified by PCR, with a positive viral load in favor of active replication. No other viral or microbiological infections were identified. MRI angiography confirmed a vasculitic process involving the left carotid artery, and a HSV-2 vasculitis diagnosis was assumed. The patient started acyclovir with improvement of clinical features and imaging abnormalities. In the HIV-infected patient, stroke is a multifactorial common cause of morbidity. The physician should take into account a broad differential diagnosis including rare causes and atypical presentations of common etiologies, including HSV-1 and HSV-2 CNS infection. Keywords Stroke . Vasculitis . HIV . HSV . Stroke in young adults
Introduction Herpesviridae is a large family of ds-DNA viruses that cause neurologic disease by primary infection and reactivation of latent infection. Both herpes simplex virus type 1 (HSV-1) and HSV-2 are neurotropic (Steiner and Benninger 2018). HSV-2 is responsible for infrequent but serious central nervous system (CNS) infections (Steiner and Benninger 2018). HSV-associated cerebrovascular disease presents as ischemia, hemorrhage, vasculitis, or venous thrombosis (Hauer et al.
* Miguel Leal Rato [email protected] 1
Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035 Lisbon, Portugal
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Faculdade de Medicina, Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-035 Lisbon, Portugal
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Serviço de Doenças Infecciosas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Prof. Egas Moniz, 1649-035 Lisbon, Portugal
2019); it more commonly affects the anterior or the anterior and posterior circulation (Hauer et al. 2019). Reports of vasculitis or stroke-like syndromes are very scarce and illcharacterized.
Case report A 23-year-old Caucasian female patient presented to the hospital with an alte
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