Neonatal herpes simplex type II virus infection complicated with meningitis and virus-associated hemophagocytic syndrome

• Published in: Japanese Journal of Clinical Immunology Vol. 35; no. 1; pp. 87 - 91
• Main Authors: HARA, Takuma, MOMOMURA, Mei, YOKOSUKA, Tomoko, IMAGAWA, Tomoyuki, KITA, Maiko, IWASAKI, Shiho, NOZAWA, Tomo, KIZAWA, Toshiki, YOKOTA, Shunpei, KIKUCHI, Masako, TANOSHIMA, Reita, ARAI, Chie, MIYAMAE, Takako
• Format: Journal Article
• Language: Japanese
• Published: Japan The Japan Society for Clinical Immunology 2012
• Subjects: acyclovir; cyclosporine; Herpes Simplex - complications; Herpes Simplex - therapy; herpes simplex type II virus infection; Herpesvirus 2, Human; Humans; Infant, Newborn; Lymphohistiocytosis, Hemophagocytic - complications; Lymphohistiocytosis, Hemophagocytic - therapy; Lymphohistiocytosis, Hemophagocytic - virology; Male; Meningitis - complications; Meningitis - therapy; VAHS
• ISSN: 0911-4300; 1349-7413; 1349-7413
• DOI: 10.2177/jsci.35.87

A 14-day-old neonate was transferred to our university hospital because of respiratory distress and mild disturbance of consciousness. He had no history of abnormal pregnancy or delivery, but had developed apnea at 6 days old. Thereafter, respiratory distress progressed and his condition deteriorated. On admission to our hospital, several vesicles were found on the left upper arm, and moderate hepatomegaly was also present. Herpes simplex virus (HSV) type II genome was detected from serum, spinal fluid, and bone marrow. Laboratory examinations revealed typical abnormalities of disseminated intravascular coagulation, increased levels of serum ferritin, aspartate aminotransferase, and lactate dehydrogenase. Bone marrow aspiration demonstrated activated macrophages and hemophagocytosis. Spinal tap revealed numerous mononuclear cells. Meningitis and virus-associated hemophagocytic syndrome (VAHS) due to systemic HSV type II infection were thus diagnosed. Acyclovir (60 mg/kg/day) and vidarabine were promptly administered. Dexamethasone palmitate and intravenous cyclosporine were also administered for systemic inflammation due to VAHS. Finally, these aggressive therapies rescued the patient without any sequelae. In general, neonatal systemic HSV infection is life-threatening and results in poor intact survival. Our case report suggests that not only antiviral treatment for HSV, but also anti-inflammatory treatment including steroid and cyclosporine should be considered from the early phase of neonatal systemic HSV infection.