Acyclovir resistance in herpes simplex virus type I encephalitis: a case report

Acyclovir resistance is rarely seen in herpes simplex virus (HSV) type I encephalitis. Prevalence rates vary between 0.5 % in immunocompetent patients (Christophers et al. 1998 ; Fife et al. 1994 ) and 3.5–10 % in immunocompromised patients (Stranska et al. 2005 ). We report a 45-year-old, immunocom...

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Bibliographic Details
Published in:Journal of neurovirology 2017-04, Vol.23 (2), p.335-337
Main Authors: Bergmann, M., Beer, R., Kofler, M., Helbok, R., Pfausler, B., Schmutzhard, E.
Format: Article
Language:English
Subjects:
Acyclovir - therapeutic use
Antiviral Agents - therapeutic use
Biomedical and Life Sciences
Biomedicine
Case Report
Disease Progression
Drug Resistance, Viral - genetics
Drug Substitution
Encephalitis, Herpes Simplex - diagnostic imaging
Encephalitis, Herpes Simplex - drug therapy
Encephalitis, Herpes Simplex - etiology
Encephalitis, Herpes Simplex - virology
Female
Foscarnet - therapeutic use
Herpes Simplex - complications
Herpes Simplex - diagnostic imaging
Herpes Simplex - drug therapy
Herpes Simplex - virology
Herpesvirus 1, Human - drug effects
Herpesvirus 1, Human - genetics
Herpesvirus 1, Human - pathogenicity
Humans
Immunology
Infectious Diseases
Leukocytosis - diagnostic imaging
Leukocytosis - drug therapy
Leukocytosis - etiology
Leukocytosis - virology
Magnetic Resonance Imaging
Middle Aged
Neurology
Neurosciences
Temporal Lobe - diagnostic imaging
Temporal Lobe - drug effects
Temporal Lobe - virology
Virology
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Summary:Acyclovir resistance is rarely seen in herpes simplex virus (HSV) type I encephalitis. Prevalence rates vary between 0.5 % in immunocompetent patients (Christophers et al. 1998 ; Fife et al. 1994 ) and 3.5–10 % in immunocompromised patients (Stranska et al. 2005 ). We report a 45-year-old, immunocompetent (negative HIV antigen/antibody testing), female patient, without previous illness who developed—after a febrile prodromal stage—aphasia and psychomotor slowing. Cerebral magnetic resonance imaging (cMRI) showed right temporal and insular T2-hyperintense lesions with spreading to the contralateral temporal lobe. Cerebrospinal fluid (CSF) analysis yielded lymphocytic pleocytosis and elevated protein level. Polymerase chain reaction testing for HSV type I showed a positive result in repeat lumbar puncture. HSV type I encephalitis was diagnosed and intravenous acyclovir treatment was initiated (750 mg t.i.d.). Acyclovir treatment was intensified to 1000 mg t.i.d., due to clinical deterioration, ongoing pleocytosis and progression on cMRI 5 days after initiation of antiviral therapy. In parallel, acyclovir resistance testing showed mutation of thymidine kinase gene at position A156V prompting foscarnet therapy (60 mg t.i.d.). Patient’s condition improved dramatically over 2 weeks. Acyclovir resistance is rare but should be considered in case of clinical worsening of patient’s condition. To our knowledge, this is the first report of acyclovir resistance in HSV type I encephalitis of an immunocompetent and previously healthy patient in Austria.
ISSN:1355-0284
1538-2443
DOI:10.1007/s13365-016-0489-5