acyclovir and Kluver-Bucy-Syndrome

Relapsing herpes simplex encephalitis (HSE) rarely occurs after acyclovir treatment. We treated a patient with relapsing HSE of the contralateral temporal lobe, resulting in Klüver-Bucy syndrome, after a full-dose acyclovir treatment. This case suggests that physicians should consider sudden behavioral and emotional changes after HSE treatment as a possible indication of relapsing HSE, as well as possible temporal lobe epilepsy, and the need to administer longer acyclovir treatment for select patients.

Topics: Acyclovir; Adult; Antiviral Agents; Brain; Dose-Response Relationship, Drug; Electroencephalography; Encephalitis, Herpes Simplex; Humans; Kluver-Bucy Syndrome; Magnetic Resonance Imaging; Male; Recurrence; Treatment Outcome

A twelve-year-old female was admitted with history of high fever, recurrent vomiting and repeated convulsion for 2 days and altered consciousness for one day. Cranial CT scan showed intraparenchymal haemorrhage involving both temporal lobes and right basal ganglia region without mass effect. Serology was reactive against IGM HSV1. Injection acyclovir was started at a dose of 10 mg/kg 8 hourly intravenously. Patient regained consciousness on fourth day but speech was altered. Abnormal behavioural symptoms were noticed. EEG showed generalised spike and slow waves and sharp and slow wave discharge more in the temporal region. The patient was given clonidine and carbamazepine. She also received behavioural therapy and parental counselling. She was followed up for six months and maintaining well.

Topics: Acyclovir; Antiviral Agents; Carbamazepine; Child; Clonidine; Encephalitis, Herpes Simplex; Female; Humans; Kluver-Bucy Syndrome; Risk Factors