Acyclovir Unresponsive Herpes Simplex Encephalitis in a child successfully treated with the addition of Foscarnet: Case report

Arch Argent Pediatr. 2019 Feb 1;117(1):e47-e51. doi: 10.5546/aap.2019.eng.e47.
[Article in En, Spanish]

Abstract

Herpes simplex encephalitis (HSE) is the most common cause of sporadic focal encephalitis worldwide. Acyclovir is the treatment of choice of HSE since the 1980s. After the widespread use of acyclovir, HSE related mortality rate had reduced but resistant strains emerged. Acyclovir resistant HSV incidence was reported as about 0.5 % and 3.5 %-10 % in immunocompetent and immunocompromised patients, respectively. Herein, a 12-year-old immunocompetent patient with HSV-1 encephalitis who was successfully treated with combined acyclovir and foscarnet therapy is described. In the case of deteriorating clinical condition under acyclovir treatment even if the absence of demonstration of increased CSF HSV viral load, the possibility of acyclovir resistant HSE and the addition of foscarnet to the acyclovir treatment might be considered.

La encefalitis por herpes simple (EHS) es la causa más frecuente de encefalitis focal esporádica en todo el mundo. El aciclovir es el tratamiento preferido para la EHS desde la década de 1980. Después del uso generalizado del aciclovir, se redujo la tasa de mortalidad relacionada con la EHS pero surgieron cepas resistentes. Se ha informado que la incidencia de virus del herpes simple (VHS) resistente al aciclovir es del 0,5 % y del 3,5 %-10 % aproximadamente en los pacientes inmunocompetentes e inmunocomprometidos, respectivamente. En este artículo, describimos el caso de un paciente inmunocompetente de 12 años de edad con encefalitis por VHS-1 tratado satisfactoriamente con aciclovir y foscarnet. En el caso de una condición clínica que desmejora con el tratamiento con aciclovir, incluso si no se demuestra un aumento de la carga viral del VHS en el líquido cefalorraquídeo, se podría considerar la posibilidad de EHS resistente al aciclovir y el agregado de foscarnet al tratamiento con aciclovir.

Keywords: Acyclovir; Child; Foscarnet; Herpes simplex encephalitis.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / pharmacology
  • Acyclovir / therapeutic use*
  • Antiviral Agents / pharmacology
  • Antiviral Agents / therapeutic use*
  • Child
  • Drug Combinations
  • Drug Resistance, Viral
  • Encephalitis, Herpes Simplex / drug therapy*
  • Foscarnet / administration & dosage*
  • Humans
  • Male
  • Remission Induction
  • Simplexvirus / drug effects
  • Treatment Failure

Substances

  • Antiviral Agents
  • Drug Combinations
  • Foscarnet
  • Acyclovir