acyclovir and Radiculopathy

We report a case of an acute HHV-7 encephalitis involving the nucleus of the VI cranial nerve in an immunocompetent host. The patient was an adult male admitted to our Clinic with headache, diplopia, fever, nausea, vertigo, asthenia and general malaise. PCR for viral and bacterial genomes was run on both serum and cerebral spinal fluid (CSF) after performing lumbar puncture, resulting positive only for HHV-7 DNA on CSF. MRI showed hyperintensity in FLAIR signal in the dorsal pons, in the area of the VI cranial nerve nucleus. Empirical therapy with Acyclovir and Dexamethasone was started at the time of admission and was continued after the microbiology results. After three days of therapy diplopia, fever and other previous clinical manifestations improved and the patient recovered normal sight. Our case report contributes to a better understanding of the presentation, diagnosis and treatment of HHV-7 encephalitis in immunocompetent patients due to reactivation in adult age.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Dexamethasone; Diagnosis, Differential; Encephalitis; Herpesvirus 7, Human; Humans; Immunocompetence; Male; Radiculopathy; Roseolovirus Infections; Treatment Outcome

Topics: Acyclovir; Analgesics; Antiviral Agents; Gabapentin; Herpes Zoster; Humans; Lumbosacral Region; Male; Middle Aged; Radiculopathy

Topics: Acyclovir; Adult; Antiviral Agents; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Radiculopathy; Spinal Puncture; Treatment Outcome; Varicella Zoster Virus Infection

Topics: Acyclovir; Adult; Antiviral Agents; Fecal Incontinence; Female; Herpes Genitalis; Herpesvirus 2, Human; Humans; Paresthesia; Radiculopathy; Recovery of Function; Sacrum; Time Factors; Urinary Retention

Herpes simplex virus 1 and 2 infections affect up to 50 million people in the United States, with a natural history of recurrent viral shedding with or without recurrence of symptoms. Although many patients remain asymptomatic or with mild symptoms, a spectrum of rare but significant nervous system complications have been reported. Although urinary retention and constipation associated with genital herpesvirus infections is often attributed to painful genital ulcerations, herpesvirus-associated lumbosacral myeloradiculitis has been reported in adults. Here, we report an 18-year-old man with constipation, urinary retention, perineal paresthesias, and erectile dysfunction in the setting of a genital herpes infection. His workup was notable for a cerebrospinal fluid pleocytosis and MRI with enhancement of the cauda equina and nerve roots, all of which are consistent with sacral myeloradiculitis. The patient was treated with a 3-week course of intravenous acyclovir with complete resolution of symptoms. Pediatric practitioners should be aware of this complication of anogenital herpes simplex virus infection because appropriate diagnosis has implications for treatment delivery and duration.

Topics: Acyclovir; Adolescent; Antiviral Agents; Constipation; Herpes Genitalis; Humans; Male; Neuralgia; Paresthesia; Radiculopathy; Sacrum; Urinary Retention

We describe a case of urinary retention caused by viral sacral myeloradiculitis (Elsberg syndrome) that occurred one week after spinal anesthesia. The differential diagnosis of urinary retention after spinal anesthesia is discussed.. A 76-yr-old male patient presented for operative removal of a right testicular hydrocele under spinal anesthesia. Anesthesia and surgery were uneventful, and he was discharged on the fifth postoperative day. Two days after discharge, he developed intermittent anal pain and voiding difficulty and was readmitted to hospital on the tenth postoperative day. He subsequently developed urinary retention, incontinence of feces, and difficulty in defecation. Magnetic resonance imaging showed no epidural hematoma, abscess, or other lesions in the spinal column, cauda equina, or spinal cord. Neurological examination showed dysesthesia in the perineal region and loss of the anal reflex and bulbocavernosus response, which indicated sacral (S4-5) radiculopathy or a lesion of the conus of the spinal cord. A cerebrospinal analysis showed slight elevation of protein without pleocytosis. After neurologic consultation, herpetic sacral myeloradiculitis was suspected and intravenous acyclovir was administered along with large doses of methylprednisolone and immunoglobulin. The symptoms gradually resolved, and the difficulty in voiding resolved 19 days after initiation of the treatment. The patient was discharged 23 days after the start of the treatment without any other complications.. This case suggests that Elsberg syndrome is important in the differential diagnosis of urinary retention after spinal anesthesia and should be discriminated from other anesthesia-related complications.

Topics: Acyclovir; Aged; Anesthesia, Spinal; Diagnosis, Differential; Herpesviridae Infections; Humans; Immunoglobulins; Male; Methylprednisolone; Radiculopathy; Time Factors; Urinary Retention

Topics: Acyclovir; Aged; Antiviral Agents; Cauda Equina; Comorbidity; Female; Herpesvirus 3, Human; Humans; Peripheral Nervous System Diseases; Radiculopathy; Sciatica; Syndrome; Treatment Outcome

Herpes simplex virus type 2 (HSV-2) can cause radiculo-myelitis as a neurological manifestation. We report a case of ongoing HSV-2 DNA positivity in the cerebrospinal fluid (CSF) of at least eight weeks under antiviral therapy with acyclovir in a highly immunocompromised hemato-oncologic patient with HSV-2-associated radiculitis. Upon admission, the patient presented with pain, leg paresis, and urinary incontinence, as well as pleocytosis in the CSF. Quantitative real-time PCR of the CSF at day 3 after admission revealed HSV-2 with a concentration of 2.0×10(5) copies/ml and treatment with acyclovir intravenously and prednisolone by mouth was started. Clinical symptoms resolved almost completely after approximately 3 weeks of antiviral therapy. However, CSF samples of day 12, 19, 26, 33, 39, 48 and 54 after admission showed a slow decline of HSV-2 DNA concentrations. HSV-2 DNA was still detectable (1.6×10(4) copies/ml) at day 54 after admission. Genotypic resistance testing showed, as far as available, no mutations indicative for acyclovir resistance. Since an increasing specific antibody index for HSV was observed, we speculate that the prolonged detectability of HSV-2 DNA in the CSF might not necessarily indicate ongoing viral replication but neutralized virus. Other hypotheses and the consequences on treatment are discussed. To our knowledge this is the first report about the long-term viral load kinetics of HSV-2 in the CSF of a patient with radiculitis under antiviral therapy, highlighting the need for further studies on HSV DNA kinetics in the CSF and their significance for an appropriate antiviral treatment.

Topics: Acyclovir; Aged; Antiviral Agents; DNA Copy Number Variations; DNA, Viral; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Lymphoma, B-Cell; Prednisolone; Radiculopathy; Real-Time Polymerase Chain Reaction; Time Factors; Viral Load

Topics: Acyclovir; Antiviral Agents; Cervical Vertebrae; Ganglia, Spinal; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness; Radiculopathy; Spinal Nerve Roots; Spondylosis; Tomography, X-Ray Computed; Virus Activation

Topics: Acyclovir; Aged; Ampicillin; Anti-Bacterial Agents; Antigens, Viral; Ceftriaxone; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Immunocompetence; Lumbar Vertebrae; Magnetic Resonance Imaging; Myelitis; Paraplegia; Radiculopathy; Spinal Cord; Spinal Nerve Roots; Treatment Outcome

Whereas valacyclovir is widely used and is recommended by some authors in moderately immunocompromised HIV-infected patients, its use has not been validated by clinical studies. We report a case of herpes zoster in an HIV-infected patient for whom neurologic complication was not avoided despite valacyclovir therapy. Clinical outcome was favorable after intravenous acyclovir. This case suggests careful monitoring of valacyclovir in HIV-infected patients is necessary.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Drug Monitoring; Electromyography; Herpes Zoster; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Middle Aged; Patient Selection; Radiculopathy; Treatment Failure; Valacyclovir; Valine; Viral Load

Topics: Acyclovir; Adult; Antiviral Agents; Female; Ganglia, Spinal; Herpes Simplex; Herpesvirus 2, Human; Humans; Hypesthesia; Leukocytosis; Myelitis; Radiculopathy; Sacrum; Syndrome; Urinary Retention

We report two cases of encephalo-myelo-radiculoneuropathy, triggered by herpes simplex virus type-1 (HSV-1) infection. Patient 1 (a 25-year-old man) and patient 2 (a 52-year-old man) were admitted to the hospital because of fever, headache, abnormal behavior, and loss of consciousness. In each case, cerebrospinal fluid (CSF) showed lymphocytic pleocytosis with protein elevation, and serum and CSF IgG antibody titers to HSV-1 were elevated markedly. Although patient 1 was treated with aciclovir in the early phase of encephalitis, he developed severe quadriparesis as a sequela. Patient 2 was treated with a combination of aciclovir and corticosteroids, and he recovered completely about 4 months after the onset of the disease. There have been only a few reports of encephalo-myelo-radiculoneuropathy triggered by HSV-1 infection. Early corticosteroid therapy was effective in our patients with post-HSV-1 infectious encephalo-myelo-radiculoneuropathy. These two patients were studied with flow cytometry for peripheral blood lymphocyte subsets during the disease course. In the active stage of the disease, the helper-inducer (CD4 + CD29+), activated T cell (CD4 + CD25+), and cytotoxic/NK (CD8 Dull + CD11b Bright+) subsets were increased compared with subsets in controls. An interesting finding was mismatched responses with an increased suppressor-inducer (CD4 + Leu8+) subset and a decreased suppressor-effecter (CD8 Bright+ CD11b Dull+) subset, indicating a possible autoimmune character of encephalo-myelo-radiculoneuropathy triggered by viral infection.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Autoimmune Diseases; Dexamethasone; Encephalomyelitis; Herpes Simplex; Herpesvirus 1, Human; Humans; Lymphocyte Subsets; Male; Middle Aged; Radiculopathy

Varicella zoster virus (VZV) is recognized as one of the major viral pathogens reactivated in patients with the acquired immune deficiency syndrome (AIDS). We report the case of meningoradiculoneuritis in an AIDS patient,associated with the isolation in the cerebrospinal fluid (CSF) of a thymidine kinase (TK)-deficient, acyclovir (ACV)-resistant strain of VZV. Although the virus was sensitive in vitro to phosphonoformate (PFA), the patient did not improve during PFA therapy and finally died. Several VZV strains isolated from this patient (including two isolates from the patient's CSF) were analyzed for their TK activity and subsequently the viral TK gene was sequenced showing a major deletion leading to a truncated protein. Their susceptibility to several antiviral agents including ACV, PFA, (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU), 9-beta-D-arabinofuranosyladenine (vidarabine), (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine (HPMPC), and (S)-9-(3-hydroxy-2-phosphonyl-methoxypropyl)adenine (HPMPA) was evaluated. All the virus strains isolated from this patient remained sensitive to HPMPA and HPMPC, pointing to the potential usefulness of these acyclic nucleoside phosphonates for the treatment of ACV-resistant VZV infections in immunocompromised patients.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Amino Acid Sequence; Base Sequence; Drug Resistance; Female; Herpes Zoster; Humans; Meningitis; Molecular Sequence Data; Neuritis; Radiculopathy; Thymidine Kinase

A rare case of encephalo-myelo- radiculitis with high herpes simplex virus type 1 (HSV-1) antibody index of CSF was reported. The case was a 43-year-old male. Double vision, cerebellar ataxia, Th4-12 truncal segmental total sensory disturbance and urinary retention were found, but those symptoms disappeared after 3 weeks of administration of acyclovir and prednisolone. Because the HSV-1 antibody index of the CSF increased significantly, the patient's disease was summarised to have been due to HSV-1, T1-intensified MRI revealed a low-intensity area in the Th5-8 region which coincided with the lesion causing the neurological symptoms, while T2-intensified MRI revealed scattered high intensity area in the cerebral hemisphere. MRI was thus useful for confirming the lesions.

Topics: Acyclovir; Adult; Antibodies, Viral; Encephalomyelitis; Herpes Simplex; Humans; Magnetic Resonance Imaging; Male; Prednisolone; Radiculopathy; Simplexvirus