Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in which the patient presented 1 year after surgical resection and radiation therapy and 1 month after chemotherapy....
Thrombophylia and COVID-19. A case report of young man 53 years old whith acu...komalicarol
A 57-year-old male was admitted to our Hospital on March 2020
for SARS-Cov2 related interstitial pneumonia. Chest x-ray showed
a bilateral interstitial-alveolar pneumonia and Blood gas analysis
(BGA) in room air highlighted a severe respiratory failure (pO2 46
mmHg, pH 7.41). Due to clinical and biohumoral worsening (stable CRP at 24 mg/dL), tocilizumab (800mg) was performed after
acquiring patient’s informed consensus. In the evening, after 96
hours of hospitalization, the patient presented a clear hyposthenia
/ hemiparesis of the right hemisome whit hyperreflexia, confusion
and slowed speech
Transverse Myelitis in a Patient with COVID-19: A Case Reportkomalicarol
There has been growing evidence of COVID-19
potentially causing a wide range of neurological abnormalities
from as mild as anosmia to as serious as stroke. It is important to
recognize that amid this pandemic, we have been seeing different
manifestations and associations of COVID-19
Guillain Barre Syndrome & Covid-19: A Case Reportclinicsoncology
Besides respiratory symptoms, coronavirus disease 2019 (COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs. Symptoms like myalgia, headaches, dizziness, anosmia, ageusia and disorder of consciousness confirms that the nervous system is involved in COVID-19 infection.
Guillain Barre Syndrome & Covid-19: A Case Reportpateldrona
Besides respiratory symptoms, coronavirus disease 2019 (COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs
Guillain Barre Syndrome & Covid-19: A Case Reportkomalicarol
Besides respiratory symptoms, coronavirus disease 2019
(COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs. Symptoms like myalgia,
headaches, dizziness, anosmia, ageusia and disorder of consciousness confirms that the nervous system is involved in COVID-19 infection. Guillain barre syndrome (GBS) is a neurological disorder
that usually follows a viral infection, it is possible that COVID-19
infection and GBS are closely related. In this case report, we try to
elucidate the relation between SARS-CoV-2 and GBS.
Abstract—Progressive Multifocal Leukoencephalopathy (PML) is seen mostly in advanced human immunodeficiency virus (HIV) infection. In some individuals, especially those with very low CD4+ counts, worsening of PML or new-onset PML can be observed after the initiation of highly active antiretroviral therapy (HAART). A case of IRIS associated PML is reported here which is much more rare as compared to PML in HIV patients unrelated to HAART. This is thought to be secondary to immune reconstitution inflammatory syndrome (IRIS). IRIS is defined as a paradoxical deterioration of a previously existing infection which is related to the immune system recovery. It is suggested to occur due to an imbalance of CD8+/CD4+ T cells. So in HIV cases with low CD4 counts and if one is on HAART then should be further investigated for IRIS and PML.
Coma Due to Wernicke Encephalopathy During Neoadjuvant Chemotherapy for Breas...semualkaira
We report the case of a 49 yr., woman who developed a coma during neoadjuvant chemotherapy for breast cancer. Brain MRI was
crucial for the diagnosis of Wernicke encephalopathy.
Thrombophylia and COVID-19. A case report of young man 53 years old whith acu...komalicarol
A 57-year-old male was admitted to our Hospital on March 2020
for SARS-Cov2 related interstitial pneumonia. Chest x-ray showed
a bilateral interstitial-alveolar pneumonia and Blood gas analysis
(BGA) in room air highlighted a severe respiratory failure (pO2 46
mmHg, pH 7.41). Due to clinical and biohumoral worsening (stable CRP at 24 mg/dL), tocilizumab (800mg) was performed after
acquiring patient’s informed consensus. In the evening, after 96
hours of hospitalization, the patient presented a clear hyposthenia
/ hemiparesis of the right hemisome whit hyperreflexia, confusion
and slowed speech
Transverse Myelitis in a Patient with COVID-19: A Case Reportkomalicarol
There has been growing evidence of COVID-19
potentially causing a wide range of neurological abnormalities
from as mild as anosmia to as serious as stroke. It is important to
recognize that amid this pandemic, we have been seeing different
manifestations and associations of COVID-19
Guillain Barre Syndrome & Covid-19: A Case Reportclinicsoncology
Besides respiratory symptoms, coronavirus disease 2019 (COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs. Symptoms like myalgia, headaches, dizziness, anosmia, ageusia and disorder of consciousness confirms that the nervous system is involved in COVID-19 infection.
Guillain Barre Syndrome & Covid-19: A Case Reportpateldrona
Besides respiratory symptoms, coronavirus disease 2019 (COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs
Guillain Barre Syndrome & Covid-19: A Case Reportkomalicarol
Besides respiratory symptoms, coronavirus disease 2019
(COVID-19), like the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), has neurological signs. Symptoms like myalgia,
headaches, dizziness, anosmia, ageusia and disorder of consciousness confirms that the nervous system is involved in COVID-19 infection. Guillain barre syndrome (GBS) is a neurological disorder
that usually follows a viral infection, it is possible that COVID-19
infection and GBS are closely related. In this case report, we try to
elucidate the relation between SARS-CoV-2 and GBS.
Abstract—Progressive Multifocal Leukoencephalopathy (PML) is seen mostly in advanced human immunodeficiency virus (HIV) infection. In some individuals, especially those with very low CD4+ counts, worsening of PML or new-onset PML can be observed after the initiation of highly active antiretroviral therapy (HAART). A case of IRIS associated PML is reported here which is much more rare as compared to PML in HIV patients unrelated to HAART. This is thought to be secondary to immune reconstitution inflammatory syndrome (IRIS). IRIS is defined as a paradoxical deterioration of a previously existing infection which is related to the immune system recovery. It is suggested to occur due to an imbalance of CD8+/CD4+ T cells. So in HIV cases with low CD4 counts and if one is on HAART then should be further investigated for IRIS and PML.
Coma Due to Wernicke Encephalopathy During Neoadjuvant Chemotherapy for Breas...semualkaira
We report the case of a 49 yr., woman who developed a coma during neoadjuvant chemotherapy for breast cancer. Brain MRI was
crucial for the diagnosis of Wernicke encephalopathy.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
Abstract—Chikunguniya can be associated with encephalitis which is a rare complication of chikunguniya. Such a rare case was attended at National University Hospital (Hondura) in August 2015, which was studied in detail. A 64 years, Honduran patient was admitted during the convalescent period of an acute febrile illness with arthralgias one month prior. Two weeks later, he developed a severe inability to form new memories disorientation to date and time; forgetting family member´s names and daily routines. The patient exhibited spontaneous crying and sadness. Premorbid cognitive, behavioral and functional abilities were normal. Patient was evaluated and investigated. On investigation Chikungunya IgM antibodies were positive and on Brain MRI revealed predominantly right medial temporal lobe hyperintensities in Diffusion weighed images; also seen in FLAIR sequences. Patient was confirmed as Chikunguniya case associated with medial temporal lobe encephalitis. So it is suggested that patients presenting with a rapidly evolving amnestic syndrome after an acute febrile illness with polyarthralgias in an endemic region should be tested for the Chikungunya virus. More cases must be described and studied, however, to better characterize this condition.
Critical Illness Polyneuromyopathy (CIPNM) is frequently present in critically ill as a certain degree of symmetric extremity paresis and respiratory muscle weakness. The consequences of this complication may last for months or years after severe illness. It prolongs the stay in ICU and dependence onmechanical ventilation, increases long-term disability and care costs. We report a 58-year old female patient admitted to our Intensive Care Unit for acute respiratory insuffi ciency due to infl uenza pneumonia and acute respiratory distress syndrome. Thirty-three days of mechanical ventilation and 11 days of extracorporal membrane oxygenation were complicated by severe CIPNM, tetraparesis, mental disorders, and diffi culties in weaning off mechanical ventilation. No specifi c therapy is available for treatment of CIPNM. Preventive, supportive and rehabilitation measures are discussed in the article.
A case report of posterior reversible encephalopathy syndrome in a patient di...bijnnjournal
Posterior reversible encephalopathy syndrome (PRES), a clinical radiological syndrome, is characterized by the
abrupt development of neurological symptoms such as headaches, convulsions, altered sensorium, and visual
problems. PRES has been linked to a number of risk factors or etiologies, including the use of immunosuppressants
or cytotoxins, hypertensive encephalopathy, eclampsia, preeclampsia, and underlying autoimmune diseases.
A 41-year-old female was admitted with acute necrotizing emphysematous pancreatitis complicated by posterior
reversible encephalopathy syndrome
Introduction: malignant syphilis is an uncommon form of secondary syphilis.This presentation usually occurs in immunocompromised patients, especially in those ones infected by human immunodeficiency virus (HIV). However, it is known that it might exceptionally affect individuals with normal immune response.
Introduction: malignant syphilis is an uncommon form of secondary syphilis.This presentation usually occurs in immunocompromised patients, especially in those ones infected by human immunodeficiency virus (HIV). However, it is known that it might exceptionally affect individuals with normal immune response.
Case report: in this manuscript, we report a case with ocular involvement in a male immunocompetent patient. He had extended skin lesions and conjunctival hyperemia on the right eye. After the laboratorial investigation we confirmed syphilis and excluded human immunodeficiency virus (HIV) infection. Considering he had uveitis, the case was conducted as neurosyphilis.and the treatment was made with Ceftriaxone, followed by excellent clinical response.
Conclusion: given the increasing number of cases of syphilis, in patients with polymorphic skin lesions associated with systemic
symptoms, it is important to exclude immunosuppression and even in immunocompetent.subjects this condition should always be a differential diagnosis.
Keywords: Malignant Syphilis; Immunocompetent; Uveitis
Ulcerative Colitis with Aseptic Abscesses Controlled by Vedolizumab: A Case R...clinicsoncology
Aseptic abscesses (AAs) are neutrophilic infiltrative lesions that often coincide with systemic inflammatory disorders such as inflammatory bowel diseases (IBD). According to recent literature, medical therapies in IBD with AAs include corticosteroid, immunosuppressants and anti-TNFα biologics.
Prevalence and Determinants of Distress Among Residents During COVID Crisisclinicsoncology
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
A Road from Coronary to Pulmonary: A Rare Imaging Presentationclinicsoncology
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Its association with Pulmonary Atresia is considered to be the most severe form, the diagnosis of which plays an important role in determination of the treatment protocol. In such cases, systemic vascular channels called Major Aortopulmonary Collateral Arteries (MAPCA’s) develop from aorta and its major branches to supply and maintain the pulmonary circulation. Such patients commonly undergo a Cardiac CT as an imperative pre-operative investigation for detailed information of these collaterals which helps plan further management. Here, we present a Case Report of an adult female patient with Pentalogy of Fallot wherein, a Cardiac CT showed the presence of dilated coronary-to-pulmonary collateral circulation. i.e. CAPA apart from the normally visualized MAPCA’s, an extremely rare occurrence.
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection mainly present severe pneumonia associated with complications related to cytokine storm syndrome. So, it was associated with thrombotic incidents like acute limb ischemia and pulmonary embolism.
Loop –Mediated Isothermal Amplification (LAMP) Based POINT-OF-CARE for Rapid ...clinicsoncology
Abstract Infectious diseases, including foodborne diseases, to this day remain a major health threat worldwide. Molecular diagnostics, based on nucleic acid (NA) amplification technologies, are in the forefront for the detection of pathogens. Polymerase chain reaction (PCR) is one of the most widely used methods for nucleic acid amplification in pathogen diagnostic.
Wen Dan Tang: A Potential Jing Fang Decoction for Headache Disordersclinicsoncology
Chinese herbal medicine is considered relatively safe, inexpensive, and easily accessible. Furthermore, it is becoming increasingly popular in the western countries. Wen Dan Tang, a Jing Fang ancient classical Chinese herbal formula, with a broad indication profile, has been used for several centuries in China to treat various illnesses.
In bioelectronic terms, the organism is understood as an integrated circuit of biological piezo, pyroelectrics, ferromagnets and semiconductors, filled with bioplasm and managed electronically by quantum processes.
Sexual Function and Dysfunction among Patients with Systemic and Auto-Immune ...clinicsoncology
Systemic autoimmune diseases affect various organs and they can determine sexual dysfunction in females and males patients particularly with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren syndrome (SS), antiphospholipid syndrome, Behçet’s disease and other vasculitis. Sexual dysfunction among patients with rheumatic diseases is multifactorial due to disease-related factors (chronic disease aspects, disease activity) as well as therapy.
The Role of the Pharmacist in Patient Care (Book Review)clinicsoncology
Most people on the outside of the health care profession are not familiar with this new role of the pharmacist. The general public has created a stereotypical pharmacist’s picture as being a person who stands behind a counter, dispenses medicine with some instructions to the respective consumer. Pharmacy practice has changed substantially in recent years.
‘Double X’ Cross Fixationin Paediatric Supracondylar Humerus Fractures: A 20-...clinicsoncology
Over the last 50 years, the developments emerged in the diagnosis and treatment of supracondylar humerus fractures (SHF) have significantly reduced the number of severe complications while certain complications with dreadful evolution, such as elbow stiffness or Volkmann’s syndrome, have completely vanished. During my residency, in 1982, on the suggestion of Prof. Pesamosca, I have performed a surgical intervention for a patient diagnosed with SHF
A hookah (shisha, waterpipe) use may increase the risk of suffering from serious symptoms due to COVID-19. Like smoking, hookahs may exacerbate the risk for severe COVID-19 through shared use and being difficult-to-clean the long pipes and having a cold water reservoir.
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...clinicsoncology
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic
Postpartum Meningitis by Enterococcus Faecalis Secondary to Neuraxial Anesthesiaclinicsoncology
Meningitis is an infrequent and serious cause of postpartum fever that requires early diagnosis and treatment to prevent serious complications and to reduce the high mortality rate
Superior Mesenteric Artery Syndrome Treated by Laparoscopic Duodenojejunostomyclinicsoncology
Superior Mesenteric Artery syndrome (SMA Sd) is a very rare disease. It is suspected in the case of intestinal obstruction in severely underweight patients. When conservative management fails surgery becomes needed, with laparoscopic duodenojejunostomy being the best approach....
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IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
Abstract—Chikunguniya can be associated with encephalitis which is a rare complication of chikunguniya. Such a rare case was attended at National University Hospital (Hondura) in August 2015, which was studied in detail. A 64 years, Honduran patient was admitted during the convalescent period of an acute febrile illness with arthralgias one month prior. Two weeks later, he developed a severe inability to form new memories disorientation to date and time; forgetting family member´s names and daily routines. The patient exhibited spontaneous crying and sadness. Premorbid cognitive, behavioral and functional abilities were normal. Patient was evaluated and investigated. On investigation Chikungunya IgM antibodies were positive and on Brain MRI revealed predominantly right medial temporal lobe hyperintensities in Diffusion weighed images; also seen in FLAIR sequences. Patient was confirmed as Chikunguniya case associated with medial temporal lobe encephalitis. So it is suggested that patients presenting with a rapidly evolving amnestic syndrome after an acute febrile illness with polyarthralgias in an endemic region should be tested for the Chikungunya virus. More cases must be described and studied, however, to better characterize this condition.
Critical Illness Polyneuromyopathy (CIPNM) is frequently present in critically ill as a certain degree of symmetric extremity paresis and respiratory muscle weakness. The consequences of this complication may last for months or years after severe illness. It prolongs the stay in ICU and dependence onmechanical ventilation, increases long-term disability and care costs. We report a 58-year old female patient admitted to our Intensive Care Unit for acute respiratory insuffi ciency due to infl uenza pneumonia and acute respiratory distress syndrome. Thirty-three days of mechanical ventilation and 11 days of extracorporal membrane oxygenation were complicated by severe CIPNM, tetraparesis, mental disorders, and diffi culties in weaning off mechanical ventilation. No specifi c therapy is available for treatment of CIPNM. Preventive, supportive and rehabilitation measures are discussed in the article.
A case report of posterior reversible encephalopathy syndrome in a patient di...bijnnjournal
Posterior reversible encephalopathy syndrome (PRES), a clinical radiological syndrome, is characterized by the
abrupt development of neurological symptoms such as headaches, convulsions, altered sensorium, and visual
problems. PRES has been linked to a number of risk factors or etiologies, including the use of immunosuppressants
or cytotoxins, hypertensive encephalopathy, eclampsia, preeclampsia, and underlying autoimmune diseases.
A 41-year-old female was admitted with acute necrotizing emphysematous pancreatitis complicated by posterior
reversible encephalopathy syndrome
Introduction: malignant syphilis is an uncommon form of secondary syphilis.This presentation usually occurs in immunocompromised patients, especially in those ones infected by human immunodeficiency virus (HIV). However, it is known that it might exceptionally affect individuals with normal immune response.
Introduction: malignant syphilis is an uncommon form of secondary syphilis.This presentation usually occurs in immunocompromised patients, especially in those ones infected by human immunodeficiency virus (HIV). However, it is known that it might exceptionally affect individuals with normal immune response.
Case report: in this manuscript, we report a case with ocular involvement in a male immunocompetent patient. He had extended skin lesions and conjunctival hyperemia on the right eye. After the laboratorial investigation we confirmed syphilis and excluded human immunodeficiency virus (HIV) infection. Considering he had uveitis, the case was conducted as neurosyphilis.and the treatment was made with Ceftriaxone, followed by excellent clinical response.
Conclusion: given the increasing number of cases of syphilis, in patients with polymorphic skin lesions associated with systemic
symptoms, it is important to exclude immunosuppression and even in immunocompetent.subjects this condition should always be a differential diagnosis.
Keywords: Malignant Syphilis; Immunocompetent; Uveitis
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Abstract Infectious diseases, including foodborne diseases, to this day remain a major health threat worldwide. Molecular diagnostics, based on nucleic acid (NA) amplification technologies, are in the forefront for the detection of pathogens. Polymerase chain reaction (PCR) is one of the most widely used methods for nucleic acid amplification in pathogen diagnostic.
Wen Dan Tang: A Potential Jing Fang Decoction for Headache Disordersclinicsoncology
Chinese herbal medicine is considered relatively safe, inexpensive, and easily accessible. Furthermore, it is becoming increasingly popular in the western countries. Wen Dan Tang, a Jing Fang ancient classical Chinese herbal formula, with a broad indication profile, has been used for several centuries in China to treat various illnesses.
In bioelectronic terms, the organism is understood as an integrated circuit of biological piezo, pyroelectrics, ferromagnets and semiconductors, filled with bioplasm and managed electronically by quantum processes.
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A hookah (shisha, waterpipe) use may increase the risk of suffering from serious symptoms due to COVID-19. Like smoking, hookahs may exacerbate the risk for severe COVID-19 through shared use and being difficult-to-clean the long pipes and having a cold water reservoir.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
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Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report and Review of Literature
1. Annals of Clinical and Medical
Case Reports
ISSN 2639-8109
Case Report
Herpes Simplex Encephalitis in Medulloblastoma Patients: Case Report
and Review ofLiterature
Al-Dabbagh M1,2,3*
, Alzahrani AS3,2
, Ashi A3,2
, Aldhubiani D3,2
and Alharbi B3,2
1
Department of Pediatrics, King Abdulaziz Medical City, P.O. Box: 65362, Jeddah 21556, Saudi Arabia
2
King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
3
King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 65362, Jeddah 21556, Saudi Arabia
1. Abstract
Encephalitis caused by Herpes Simplex Virus (HSV) and medulloblastoma are both fairly rare
disorders with relatively poor prognoses. We experienced a case of HSV encephalitis (HSE) in
which the patient presented 1 year after surgical resection and radiation therapy and 1 month
after chemotherapy. The patient had a good initial response to a 3 weeks course of IV acyclovir;
2. Key Words:
Medulloblastoma; Neuroectodermal
Tumors; Primitive; Encephalitis; Her-
pes Simplex; Viral Encephalitis
3. Introduction
however, he presented with infection relapse 5 days after hospital discharge with major neurolog-
ical manifestation and progressive gliosis. A review of the literature for similar reported cases was
done and we stressed on the importance of confirming a negative HSV polymerase chain reaction
(PCR) test from the cerebrospinal fluid (CSF) prior to discontinuation of therapy, especially in
the immune compromised hosts.
irradiations as a risk factor for the virus reactivation and HSV
Medulloblastoma is the most common malignant solid tumor
in childhood, with the highest frequency among other brain tu-
mors accounting for 30% of pediatric brain tumors and 7% to 8%
of all brain tumors. According to the World Health Organization
(WHO), medulloblastoma is classified as a grade IV tumor and
defined as “a malignant, invasive embryonal tumor of the cerebel-
lum with preferential manifestation in children, predominantly
neuronal differentiation and an inherent tendency to metastasize
via cerebrospinal (CSF) pathways [1,2].
Herpes simplex virus is a worldwide common viral infection that
starts as a latent infection then reactivates causing genital or cuta-
neous herpes, conjunctivitis, encephalitis, keratitis, or eczema her-
peticum. Herpes simplex virus encephalitis (HSE) is considered as
a very rare disease associated with high mortality rate that reaches
70% if left untreated [3]. An estimated worldwide incidence is one
case per 250,000–500,000 individuals per year in which reactiva-
tion of the infection accounts for 70% of all HSE cases [3] while
moderate to severe sequelae have been reported in 35-70% of the
cases [4]. Multiple factors contribute to the reactivation of HSV,
such as fever or exposure to ultraviolet light. Furthermore, studies
suggested that reactivation is due to a multisystem process under
the influence of neuronal, immune, and viral factors rather than
a single factor [5]. Radiotherapy (RT) can trigger the reactiva-
tion of oral HSV infection, with raised concerns of having brain
*Corresponding Author (s): Mona Al-Dabbagh, Department of Pediatrics, King Abdulaziz
Medical City, King Abdullah International Medical Research Centre, King Saud bin Abdulaziz
University for Health Sciences, P.O. Box: 65362, Jeddah 21556, Saudi Arabia, E-mail: Dab-
baghM@ngha.med.sa
http://www.acmcasereport.com/
encephalitis [6]. Although HSV encephalitis triggered by neuro-
surgical procedures is a rare occurrence, neurosurgical procedures
have occasionally been reported as precipitating factors for HSE
[7-11]. In neurosurgical patients, postoperative HSE may involve
areas of the brain other than the temporal lobe, resulting in atyp-
ical presentations. HSE has also been described in patients with
Central Nervous System (CNS) tumors, including CNS lympho-
ma, spinal ependymoma, astrocytomas and high-grade gliomas,
in whom the diagnosis of encephalitis may be delayed due to the
confounding clinical presentations [12-15]. In these cases, cranial
radiation therapy was the most commonly reported risk factor for
disease development [16], while other reports described temozolo-
mide-based chemoradiation as a contributing factor [17]. Here we
report a case of relapsed necrotizing HSE that occurred in a child
who received chemo-radiation for medulloblastoma treatment and
present a review of the current literature for similar cases of HSE
occurring in medulloblastoma patients.
4. Case report
A 9-year-old Saudi male who is known to have anaplastic medullo-
blastoma presented to the emergency room (ER) at King Abdulaziz
Medical City in Jeddah, Saudi Arabia with fever and headache for
3 days associated with behavioural changes, decreased Level of
Consciousness (LOC), irritability and decreased activity for 2 days.
In the ER, he developed an attack of left sided seizure, which was
Citation: Al-Dabbagh M,Herpes Simplex Encephalitis in MedulloblastomaPatients: Case Report
and Review of Literature. Annals of Clinical and Medical Case Reports. 2020; 4(1): 1-3.
Volume 4 Issue 1- 2020
Received Date: 01 May 2020
Accepted Date: 18 May 2020
Published Date: 20 May 2020
3. Volume 4 Issue 1-2020 Case Report
http://www.acmcasereport.com/ 3
Table 1: A summary table of the reported cases of medulloblastoma and HSV encephalitis
In our case, the patient underwent complete resection of the me-
dulloblastoma followed by radiation therapy. One month after
chemotherapy, he developed HSE and was treated with acyclovir
for total 3 weeks with good clinical recovery; however, lumbar tap
was not repeated as the test is not available in house and the deci-
sion for discontinuation was made based on clinical assessment.
Unfortunately, relapse of the infection happened soon after being
discharged, which resulted in significant consequences and neuro-
logical sequelae.
HSE in medulloblastoma, to our knowledge, was reported in two
cases in the literature and both cases occurred after chemo-radia-
tion [6, 18]. In the first case reported by Molloy S et al, a 22-year-
old lady presented with confusion 3 weeks after receiving stereo-
tactic RT with adjunctive chemotherapy and steroids for treatment
of medulloblastoma recurrence. Her clinical condition deteriorat-
ed rapidly afterwards and died 15 days after admission. Post-mor-
tem HSV polymerase chain reaction (PCR) tests on brain tissue
revealed presence of HSV [6]. The second case was reported by
Saran et al. among a series of 13 other cases of recurrent medul-
loblastoma treated with stereotactic conformal external beam ra-
diotherapy (SCRT) [18]. This case developed clinical deterioration
3 weeks following SCRT and postmortem examination confirmed
HSE and progressive medulloblastoma[18].
Reactivation of oral HSV during chemo-radiotherapy is a very well
recognized setup of the virus given the established viral latency and
opportunism [19, 20]; however, HSE encephalitis is not more com-
mon in immunocompromised compared to healthy hosts, and thus
relapses of HSE is even more unusual to happen and had been very
rarely reported in these patients [17,21].
The cause of HSE relapse is not very clear; some studies attributed
it to ongoing viral replication. On the other hand, Dannett et al,
explained in 5 cases of relapsed HSE that the cause of relapse was
not due to active viral replication and expounded it to an on-go-
ing immune-mediated and inflammatory reaction to the infection
[22]. One possible explanation of relapse in our case would be the
severe state of immunosuppression where immunity is unable to
overcome the infection despite proper therapy. Another possible
explanation would be related to inadequate dose/duration of ther-
apy. Otherwise, this could be due to be the development of acyclo-
vir resistance in the settings of immunosuppression. However, this
explanation is not very well justified, given that our case responded
clinically to acyclovir after the resumption of the same dose of ther-
apy. Unfortunately, at that time, major neurological damage had
already occurred.
The initial clinical trials on Acyclovir duration in HSV encephalitis
suggested 10 days of therapy [23, 24]. However, and given the high
rate of relapse rate with such duration, further recommendations
advised for extending the duration to 14-21 days [25-31]. Some
experts suggest confirming a negative CSF PCR result at the end of
therapy especially in cases that lack appropriate clinical response,
and advise for guiding the duration of antiviral therapy based on
confirmed negative tests [27, 32]. This approach is even advocat-
ed by the British Neurologists and British Pediatric Allergy, Im-
munology and Infectious Diseases Group and adds an additional
recommendation of at least 21 days of acyclovir treatment in the
immunocompromised population [29].
6. Conclusion
HSE appears as a significant cause of morbidity and mortality in
immunocompromised patients. These patients in particular are at
considerable risk of HSE relapse, thus extended duration of IV acy-
clovir therapy guided by CSF examination and confirmed negative
HSV PCR is advocated.
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