Herpes simplex encephalitis (HSE) followed a biphasic course with relapse in 3 children aged 11 years, 9 months, and 11 months reported from the Hospital for Sick Children, London and South Hampton General Hospital, England. All 3 presented with fever and seizures and relapse was accompanied by generalized or hemi-chorea in 2 patients. All patients received repeat courses of acyclovir, antibiotics and anticonvulsants. Dexamethasone was added in the older patient and the acyclovir course was followed by vidarabine in 2 patients. All patients had residual sequelae at discharge: 1 had a mild right facial weakness and persisting dysphasia, another was severely handicapped with persisting chorea and a third was visually inattentive and had a right hemiplegia and left hemichorea. The cause of the relapse was not definitely determined. A possible resistant organism might indicate a longer initial course of high dose acyclovir or alternatively, a post-infectious neuroallergic process might suggest the substitution of immunomodulatory treatment in place of further antiviral treatment. [1]
COMMENT. Relapsing herpes simplex encephalitis is not uncommon in adults but is rare in children. Chorea in association with HSE relapse is of interest. The authors refer to 7 additional patients reported in the literature.
Autism is another unusual sequel to herpes simplex encephalitis described in a 31 year old adult at the University of Goteborg, Sweden [2]. Other cases in the literature have occurred in pre-adolescence. Autism is not necessarily a developmental disorder and temporal lobe damage caused by herpes encephalitis may explain some cases. The Kluver-Bucy syndrome, characterized by emotional instability, hypersexuality and hyperorality, has also been described as a complication of herpes encephalitis when both temporal lobes have been involved.