Prolonged detection of herpes simplex virus type 2 (HSV-2) DNA in cerebrospinal fluid despite antiviral therapy in a patient with HSV-2-associated radiculitis

• Published in: Antiviral therapy Vol. 17; no. 1; pp. 125 - 128
• Main Authors: GANZENMUELLER, Tina, KARAGUELLE, Deniz, SCHMITT, Corinna, PUPPE, Wolfram, STACHON-KUNSTYR, Rita, BRONZLIK, Paul, SAUERBREI, Andreas, WEGNER, Florian, HEIM, Albert
• Format: Journal Article
• Language: English
• Published: London International Medical Press 2012
• Subjects: acyclovir; Acyclovir - administration & dosage; Acyclovir - therapeutic use; Aged; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antibodies; Antiviral agents; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Biological and medical sciences; Case reports; Cerebrospinal fluid; DNA Copy Number Variations; DNA, Viral - cerebrospinal fluid; Female; Herpes Simplex - cerebrospinal fluid; Herpes Simplex - complications; Herpes Simplex - drug therapy; Herpes Simplex - virology; Herpes simplex virus 2; Herpesvirus 2, Human - genetics; Herpesvirus 2, Human - isolation & purification; Humans; Kinetics; Leg; Lymphoma, B-Cell - cerebrospinal fluid; Lymphoma, B-Cell - complications; Lymphoma, B-Cell - drug therapy; Lymphoma, B-Cell - virology; Medical sciences; Mouth; Mutation; Pain; Paresis; Pharmacology. Drug treatments; Pleocytosis; Polymerase chain reaction; Prednisolone; Prednisolone - administration & dosage; Prednisolone - therapeutic use; Radiculopathy - cerebrospinal fluid; Radiculopathy - complications; Radiculopathy - drug therapy; Radiculopathy - virology; Real-Time Polymerase Chain Reaction; Replication; Time Factors; Viral Load; Virus; Human; Treatment; Herpesviridae; DNA; Alphaherpesvirinae; Human herpesvirus 2; Antiviral; Patient; Cerebrospinal fluid; Detection; Prolonged
• ISSN: 1359-6535; 2040-2058
• DOI: 10.3851/IMP1924

Herpes simplex virus type 2 (HSV-2) can cause radiculo-myelitis as a neurological manifestation. We report a case of ongoing HSV-2 DNA positivity in the cerebrospinal fluid (CSF) of at least eight weeks under antiviral therapy with acyclovir in a highly immunocompromised hemato-oncologic patient with HSV-2-associated radiculitis. Upon admission, the patient presented with pain, leg paresis, and urinary incontinence, as well as pleocytosis in the CSF. Quantitative real-time PCR of the CSF at day 3 after admission revealed HSV-2 with a concentration of 2.0×10(5) copies/ml and treatment with acyclovir intravenously and prednisolone by mouth was started. Clinical symptoms resolved almost completely after approximately 3 weeks of antiviral therapy. However, CSF samples of day 12, 19, 26, 33, 39, 48 and 54 after admission showed a slow decline of HSV-2 DNA concentrations. HSV-2 DNA was still detectable (1.6×10(4) copies/ml) at day 54 after admission. Genotypic resistance testing showed, as far as available, no mutations indicative for acyclovir resistance. Since an increasing specific antibody index for HSV was observed, we speculate that the prolonged detectability of HSV-2 DNA in the CSF might not necessarily indicate ongoing viral replication but neutralized virus. Other hypotheses and the consequences on treatment are discussed. To our knowledge this is the first report about the long-term viral load kinetics of HSV-2 in the CSF of a patient with radiculitis under antiviral therapy, highlighting the need for further studies on HSV DNA kinetics in the CSF and their significance for an appropriate antiviral treatment.