Herpes Simplex Virus-2 Meningoencephalitis With Abducens Nerve Palsy With Literature Review

Abstract

Herpes simplex virus (HSV), a human alpha herpes virus, is responsible for most infections caused by herpes viruses worldwide. Among the herpes simplex viruses, both HSV 1 and 2 cause significant morbidity. HSV-2 accounts for most genital infections with extragenital complications involving the groin, thigh, or other pelvic areas. HSV-2 is the leading viral cause of sexually transmitted diseases. Viral dissemination via the blood or the cutaneous route during primary infection can affect joints, liver, lungs, spinal cord, and brain. HSV-2, by nature of its higher reactivation frequency, leads to clinical reactivation or subclinical shedding, resulting in increased transmission risk during unprotected sexual encounters. HSV-2 reactivation can result in lesions involving the fingers, skin, eyes, brain, and visceral organs such as the esophagus, lung, and liver. Ocular involvement results in keratitis, blepharitis, conjunctivitis, and rarely necrotizing retinitis. Oculomotor cranial nerve involvement by HSV is a rare entity even in patients with human immunodeficiency virus infection. Clinical features associated with reactivation are seen in primary infections, especially in children and adolescents. A medical literature search resulted in a few cases caused by a varicella-zoster virus but none by HSV. Here we describe a young female with a newly diagnosed meningoencephalitis and abducens nerve palsy (first case) due to a primary HSV infection. She came to the emergency department with headache, confusion, abnormal behavior and later developed diplopia as an inpatient. She was treated successfully with two weeks of acyclovir.