انسفاليت هرپسي براساس قضاوت باليني در بارداري: گزارش موردي

Herpetic encephalitis based on clinical judgment in pregnancy: case report

زمينه و هدف: عفونت هرپس سيمپلكس در زن باردار به‌ندرت منجر به انسفاليت مي‌گردد. در اين عفونت بروز تظاهرات نورولوژيك ناشايع است. اين گزارش موردي به معرفي يك زن باردار با تشخيص انسفاليت هرپسي به‌دنبال تشنج پرداخته است كه بررسي‌هاي تشخيصي اوليه منفي بود. معرفي‌بيمار: بيمار زن 23 ساله با سن حاملگي 29 هفته بود كه از سه روز پيش دچار ضعف، سردرد، تب و ضعف شناختي شده و به‌دنبال تشنج به بيمارستان مراجعه نموده بود. در واكنش زنجيره‌اي پليمراز (PCR)، مايع مغزي-نخاعي از نظر هرپس منفي بود. با توجه به علايم بيمار با شك قوي به انسفاليت هرپسي، بيمار تحت درمان با آسيكلووير قرار گرفت كه با بهبود علايم باليني همراه بود و در هفته 36 بارداري نوزاد سالم به دنبال زايمان طبيعي متولد شد. نتيجه‌گيري: انسفاليت هرپسي يك بيماري نادر و خطرناك مي‌باشد، ازاين‌رو حتي در بيمار حامله با علايم آتيپيك اقدامات تشخيصي و درماني مناسب انجام مي‌شود.

Background: Herpes simplex virus (HSV) encephalitis is the most common cause of sporadic encephalitis, with significant morbidity and mortality that are effectively reduced by antiviral treatment. Herpes simplex infection in pregnant women rarely results in encephalitis. The most common symptoms of a pregnant woman with herpes simplex infection are colds and skin vesicles. Herpetic encephalitis occurs during pregnancy in the third trimester in 60% of cases and with less prevalence in the second trimester. Among HSVs most, HSV-1 causes encephalitis. Early diagnosis and timely treatment are important as mortality decreases from 70% to 20-30%. This case report, reviews a pregnant woman with a diagnosis of herpes encephalitis due to seizure and consciousness disorder, which was negative in polymerase chain reaction (PCR) assay and diagnostic studies. Case Presentation: The patient was a 23-year-old woman with a gestational age of 29 weeks who presented with fever, headache, delirium, and cognitive impairment three days prior to admission following seizure. Early magnetic resonance imaging (MRI) showed an increase in the cortical signal in the temporal lobe and PCR assay for the detection of herpes virus was negative. Magnetic resonance venography also showed an increase in the left maxillary sinus with differential diagnosis of herpetic encephalitis. Considering the symptoms of the patient with a strong suspicion of herpes simplex encephalitis, the patient was treated with acyclovir, which was associated with improvement of clinical symptoms. Finally, normal delivery was performed after 36 weeks of gestation. Conclusion: Given that herpes simplex virus encephalitis is a rare and potentially dangerous and complicated disease, it is imperative for a pregnant patient with atypical symptoms to be identified with an appropriate diagnostic and therapeutic measures.