1例严重单纯疱疹病毒脑炎的辅助治疗效果有限:1例报告及文献复习

IF 1 Q4 INFECTIOUS DISEASES
IDCases Pub Date : 2025-01-01 DOI:10.1016/j.idcr.2025.e02307
Xiao-Ling Zhong, Chen-Li Yang, Xiao-Long Yu, Ling Wang
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引用次数: 0

摘要

1型单纯疱疹病毒(HSV-1)脑炎是一种严重的神经系统疾病,尽管抗病毒治疗,但死亡率和发病率很高。辅助免疫调节治疗如静脉注射免疫球蛋白(IVIG)和糖皮质激素的作用仍不确定。我们报告了一例致命的严重HSV-1脑炎病例,患者为一名59岁男性,尽管接受了阿昔洛韦、IVIG(0.4 g/kg/day)和甲基强的松龙(80 mg/day)联合治疗,但仍出现出血性坏死。脑脊液PCR和MRI证实了诊断,随后的影像学显示进行性左半球出血需要手术清除。患者神经功能恶化,于第56天死亡。该病例增加了越来越多的证据,质疑辅助IVIG/类固醇治疗晚期HSV-1脑炎的疗效,特别是出血并发症。虽然一些研究表明在炎症期有潜在的益处,但我们的经验强调了它们在危重病例中的局限性。需要更多的研究来确定哪些患者可能受益于免疫调节和最佳治疗时机。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Limited efficacy of adjunctive therapy in a case of severe herpes simplex virus encephalitis: A case report and literature review
Herpes simplex virus-1 (HSV-1) encephalitis is a severe neurological disease with high mortality and morbidity despite antiviral therapy. The role of adjunctive immunomodulatory treatments like intravenous immunoglobulin (IVIG) and glucocorticoids remains uncertain. We report a fatal case of severe HSV-1 encephalitis in a 59-year-old man who developed hemorrhagic necrosis despite combined treatment with acyclovir, IVIG (0.4 g/kg/day), and methylprednisolone (80 mg/day). CSF PCR and MRI confirmed the diagnosis, with subsequent imaging showing progressive left hemispheric hemorrhage requiring surgical evacuation. The patient deteriorated neurologically and died on day 56. This case adds to growing evidence questioning the efficacy of adjunctive IVIG/steroids in advanced HSV-1 encephalitis, particularly with hemorrhagic complications. While some studies suggest potential benefits during the inflammatory phase, our experience highlights their limitations in critical cases. More research is needed to identify which patients might benefit from immunomodulation and optimal treatment timing.
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来源期刊
IDCases
IDCases INFECTIOUS DISEASES-
CiteScore
2.60
自引率
6.70%
发文量
300
审稿时长
10 weeks
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