Type 2 herpes simplex virus-induced anti-N-methyl-D-aspartate receptor encephalitis responsive to immunoglobulin monotherapy

J Neurovirol. 2024 Aug;30(4):445-449. doi: 10.1007/s13365-024-01228-5. Epub 2024 Aug 19.

Abstract

Herpes simplex virus-2 encephalitis (HSV2E) in immunocompetent adults is exceptionally rare, and the subsequent onset of autoimmune encephalitis after HSV2E is even less common. This report presents the inaugural Chinese case of anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) induced by HSV2E, confirmed via metagenomic next-generation sequencing (mNGS). The patient demonstrated a favorable response to intravenous immunoglobulin (IVIG) monotherapy. This case emphasizes the importance of considering autoimmune encephalitis in patients exhibiting new or recurrent neurological symptoms after HSV2E recovery. Comprehensive mNGS and neuronal antibody testing are essential for timely diagnosis. Moreover, IVIG monotherapy can serve as an effective treatment for NMDARE induced by HSV2, providing a viable alternative, particularly when steroid therapy is contraindicated.

Keywords: Anti-N‐methyl‐d‐aspartate receptor encephalitis; Herpes simplex virus type 2; Intravenous immunoglobulin; Viral encephalitis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / drug therapy
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / immunology
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / virology
  • Encephalitis, Herpes Simplex* / drug therapy
  • Encephalitis, Herpes Simplex* / immunology
  • Encephalitis, Herpes Simplex* / virology
  • Female
  • Herpesvirus 2, Human* / drug effects
  • Herpesvirus 2, Human* / genetics
  • Herpesvirus 2, Human* / immunology
  • Humans
  • Immunoglobulins, Intravenous* / therapeutic use
  • Male
  • Treatment Outcome

Substances

  • Immunoglobulins, Intravenous