Herpes simplex virus 2: a rare cause of ascending encephalomyelitis (P2.311)

Objective: To discuss a case of ascending HSV 2 encephalomyelitis and present a review of the literature of HSV type 1 and 2 infections resulting in myelitis and encephalomyelitis. Background: Ascending encephalomyelitis is a rare complication of herpes simplex virus (HSV2) infection that often presents with lower extremity weakness and quickly progresses, and in many cases develops into a necrotizing myelitis. If not discovered and treated in a timely manner, most patients may be left with a poor prognosis. Design/Methods: A 79 year old immunocompetent male who presented from an outside hospital with suspected AIDP with one week of bilateral leg weakness, numbness, and an inability to walk, urinary retention, absent reflexes, diminished rectal tone, and a sensory level at T4. CT of the spine revealed no abnormalities, MRI could not be obtained due to a non-compatible cardiac pace maker. CSF revealed a xnathochromic sample with RBC of 5/uL, WBC 504/uL (96% lymphocytes), protein of 280 mg/dL, glucose 41 mg/dL, and a PCR revealed HSV 2 infection. He quickly developed hypophonia, and later hypotension and respiratory distress. Treatment with acyclovir was started, but was without clinical benefit. Results: We discuss a case of ascending HSV2 encephalomyelitis, and present a review of published literature of HSV 1 and 2 associated encephalomyelitis and ascending myelitis. Conclusions: HSV 2 infection is a rare cause of ascending encephalomyelitis often associated with a poor outcome. A high clinical suspicion for HSV infection in a patient presenting with myelopathic signs and symptoms along with early detection and treatment should always be considered. Disclosure: Dr. Kesayan has nothing to disclose. Dr. Hurst has nothing to disclose.