An Official publication of The Asian Congress of Neurological Surgeons (AsianCNS)

Search Article
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Advertise Subscribe Contacts Login  Facebook Tweeter
  Users Online: 142 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
 
CASE REPORT
Ahead of Print

A rare case of concurrent herpes simplex encephalitis and glioblastoma multiforme


1 Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
2 Department of Neurosurgery, Hull Royal Infirmary, Hull, United Kingdom
3 Department of Neuropathology, Hull Royal Infirmary, Hull, United Kingdom

Correspondence Address:
Parag Sayal,
Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, WC1N 3BG
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None

Herpes encephalitis superimposed on an intracranial malignancy has previously been described mainly in the context of malignancy imitating infection or in the postoperative setting after neurosurgical intervention. We report a rare case of de novo presentation of concurrent herpes encephalitis and glioblastoma. A 63-year-old man presented with status epilepticus and subsequent magnetic resonance imaging (MRI) brain showed a right temporal enhancing lesion with mass effect. He underwent a craniotomy and debulking of this lesion, which on subsequent histology was positive for herpes simplex virus (HSV) antigens and HSV DNA was confirmed by polymerase chain reaction analysis. The sample however also had some hypercellular areas with atypical astrocytes. Our patient recovered well from surgery and was eventually commenced on acyclovir albeit with a delay of 3 weeks due to the initial diagnostic dilemma. However, he re-presented with lethargy and confusion a further 3 weeks later and an MRI scan showed recurrence of the temporal lesion with MR spectroscopy more suggestive of high-grade glioma. He, therefore, underwent a further debulking surgery and the histology revealed a WHO Grade 4 glioblastoma with some residual areas of inflammation. A diagnosis of 2 co-existing pathologies namely HSV encephalitis and glioblastoma was thus reached. Unfortunately, due to poor performance status, he could not undergo chemo-radiotherapy and died 8 months after presentation. Immuno-modulators, expressed locally and globally in glioma patients, are likely to render them susceptible to infections. There are an increasing number of reports of HSV encephalitis in the glioma setting postoperatively. However, we report a de novo presentation which has only been recognized once before in the 1970s. Recognition of HSV encephalitis in glioma patients in the de novo and also the postoperative context is important for commencing early treatment and preventing poor outcomes.


Print this article
Search
 Back
 
  Search Pubmed for
 
    -  Sayal P
    -  Zafar A
    -  Highley R
 Citation Manager
 Article Access Statistics
 Reader Comments
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed709    
    PDF Downloaded13    

Recommend this journal