Herpetic encephalitis in a patient with SARS-CoV-2 infection: A case report.
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Abstract
Case 5-year-old girl, referred with 5 hours of evolution of generalized tonic-clonic convulsive episodes, gaze eversion and sphincter relaxation, jugularized with midazolam and phenytoin. In addition, the mother reported that for the last month and a half she had been presenting persistent unquantified fever and multiple lesions in the oral cavity. The patient is the result of second gestation, vaginal delivery with gestational age of 40.5 weeks, birth weight 3500 grams, height 53 cm, spontaneous neonatal adaptation, incomplete vaccination schedule pending vaccination at one year of age, adequate motor and social neurodevelopment. On physical examination normal vital signs, she was drowsy, Glasgow 13/15, with multiple vesicular lesions on lower lip and gums, erythematous edematous oropharynx. Paraclinical PCR-SARS-CoV-2 positive, hemogram with normocitic-hypochromic anemia, the rest within normality. Report of cerebrospinal fluid filmarray detected the presence of herpes simplex virus 1 (HVS-1). In view of these findings, it was decided to transfer him to P-ICU where he required mechanical ventilation due to severe respiratory compromise, he continued with anticonvulsant levetiracetam and was started on acyclovir.
Conclusion The association between SARS CoV-2 and Herpes simplex in the cases reported in the pediatric population, its clinical course and long-term neurological complications may have repercussions in the following years of life. Coexistence of neuroinfection and respiratory infections by SARS CoV-2, as well as CNS involvement, continues to be studied.
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