The Many Faces of Neurological Neonatal Herpes Simplex Virus Infection

Abstract

This case series explores the various manifestations of central nervous system (CNS) involvement in neonatal herpes simplex virus (HSV) infection and highlights the challenges involved in their diagnosis and treatment. Neonatal HSV infection is a rare but serious condition that can have significant neurological consequences. The article presents three cases of neonatal HSV infection, all involving the CNS, each characterized by distinct clinical features and outcomes. Case 1 describes a three-week-old male with severe HSV meningoencephalitis resulting in poor response to treatment and death. Cases 2 and 3 describe younger neonates who presented early in the disease course with disseminated infection and skin, eye, and mouth (SEM) lesions. Although both patients had CNS involvement, their outcomes were remarkably favorable. The wide range of clinical presentations of CNS manifestations in neonatal HSV infection, ranging from nonspecific to evident neurological symptoms, underscores the need for a high index of suspicion and comprehensive evaluation to ensure early diagnosis and appropriate treatment. However, it also notes that even with timely treatment, some cases may still have a poor prognosis.

Keywords: herpes simplex virus infection; hsv encephalitis; hsv pcr; neonatal hsv infection; neonatal sepsis.

Figure 1. Diffusion-weighted axial MRI images of the brain (A, B, and C) show multiple areas of acute infarcts including the brainstem (arrow in A), left thalamus (arrow in B), and left motor cortex (arrow in C). Contrast-enhanced T1-weighted axial MRI image of the brain (D) at the level of the cerebellum shows extensive leptomeningeal enhancement (arrow in D).

Figure 2. Axial fluid-attenuated inversion recovery (FLAIR) MRI image (A) on the follow-up MRI performed after 10 days shows laminar necrosis (arrow) and encephalomalacia in left frontal lobe. Susceptibility-weighted axial MRI image (B) shows hemosiderin from hemorrhage (arrow) in the left thalamus.

Figure 3. Contrast-enhanced T1-weighted axial MRI image of the brain shows leptomeningeal enhancement (arrow).

Figure 4. T1-weighted axial MRI image of the brain without the administration of intravenous contrast agent shows foci of hemorrhage in parietal white matter bilaterally (arrows).