acyclovir and Neuromuscular-Diseases

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adrenal Cortex Hormones; Capsaicin; Carbamazepine; Demyelinating Diseases; Ganciclovir; HIV-1; HTLV-I Infections; Humans; Muscular Diseases; Neuritis; Neuromuscular Diseases; Peripheral Nervous System Diseases; Polyneuropathies; Zidovudine

Japanese encephalitis (JE) is a clinical disease caused by inflammation of the central nervous system. The symptoms of this disease range broadly in severity from mild febrile illness to acute meningomyeloencephalitis. JE has been associated with a variety of neurological abnormalities, such as altered sensorium, seizures, focal neurological deficit, and acute flaccid paralysis (AFP). However, to date, AFP has never been reported as an initial manifestation of JE. Here, we present a case of AFP manifesting as the initial symptom of JE in a Chinese patient. A 30-year-old Chinese man was admitted to the West China Hospital of Sichuan University after experiencing AFP in the right upper limb, followed by hyperpyrexia and unconsciousness. Assay of cerebrospinal fluid from a lumbar puncture revealed high levels of proteins and anti- JE virus IgM antibodies. Intravenous acyclovir was administered; however, the weakness persisted and more extensive muscle wasting from the proximal to distal right upper limb occurred over 7 months. This case report highlights that JE needs to be added to the differential diagnosis of AFP in adults, especially in JE endemic seasons and areas.

Topics: Acyclovir; Administration, Intravenous; Adult; Antibodies, Viral; Antiviral Agents; Central Nervous System Viral Diseases; China; Encephalitis Virus, Japanese; Encephalitis, Japanese; Humans; Immunoglobulin M; Male; Myelitis; Neuromuscular Diseases; Treatment Outcome

Two children, an eight-year-old girl and a seven-month-old boy, recovered from herpes simplex encephalitis with minimal neurological residua following acyclovir treatment. Subsequently, they experienced marked deterioration, interpreted as either recrudescent infection or a post-infectious phenomenon. Features of the deterioration included encephalopathy and hyperkinetic movement disorder. MRI studies showed extensive neocortical damage, without involvement of the basal ganglia, thalamus or subthalamic nuclei. With aggressive supportive care, both children made a slow, steady recovery over several months. This supportive care is best provided in a closely supervised interdisciplinary setting.

Topics: Acyclovir; Brain; Brain Damage, Chronic; Child; Dose-Response Relationship, Drug; Drug Administration Schedule; Encephalitis; Female; Follow-Up Studies; Herpes Simplex; Humans; Infant; Magnetic Resonance Imaging; Male; Neurocognitive Disorders; Neurologic Examination; Neuromuscular Diseases

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Drug Therapy, Combination; Humans; Male; Middle Aged; Neuromuscular Diseases; Time Factors; Zidovudine