SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Herpes Simplex Virus Associated Myelitis

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This report describes a rare case of herpes simplex virus type 1 (HSV-1) myelitis in a 52-year-old man with no significant past medical history. He presented with back pain that rapidly progressed over several days to ascending tingling, sensory level changes up to the nipple line, leg weakness, and inability to walk. On examination, he had myelopathic signs from the T2–T3 level downward, including hyperreflexia and upgoing Babinski reflexes.<br /><br />Initial non-contrast MRI of the full spine showed no cord compression, only a small T3 superior endplate fracture without significant height loss or retropulsion. Because he also had constipation, urinary retention with overflow leakage, and ongoing neurologic deficits, a Foley catheter was placed and repeat contrast MRI of the cervical and thoracic spine was obtained, again without abnormal enhancement. Since imaging was unrevealing, lumbar puncture was eventually performed.<br /><br />CSF polymerase chain reaction (PCR) was positive for HSV-1, confirming the diagnosis. Testing for other infectious causes, including varicella-zoster virus, West Nile virus, syphilis, Lyme disease, and fungal infection, was negative. Serum studies for hepatitis, cryptococcus, HIV, and syphilis were also negative, though mild liver enzyme elevation was noted.<br /><br />The patient was treated with intravenous acyclovir and showed some improvement in motor strength, though sensation initially did not improve. He was discharged to acute rehabilitation to complete a 3-week course of IV acyclovir, after which he experienced further motor and sensory improvement. He continues outpatient physical therapy.<br /><br />The authors emphasize that HSV myelitis is rare, especially HSV-1-related cases, and may present with ascending sensorimotor deficits and urinary symptoms. They highlight that spinal MRI can be falsely negative, making CSF PCR the diagnostic gold standard.

Asset Subtitle

Tanveer Singh

Meta Tag

Author List Harjot Kaur, Karandeep Bumrah, Rama Nanah, Tanveer Singh, Tanveer Singh

Category Clinical Vignettes

Concept HSV Myelitis

Concept Cerebrospinal Fluid Polymerase Chain Reaction

Concept Ascending Sensory-Motor Symptoms

Concept Intravenous Acyclovir

Concept Hyperreflexia

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic

Presenting Author Tanveer Singh

Track Adult

Keywords

HSV-1 myelitis

herpes simplex virus type 1

ascending sensory deficits

spinal cord inflammation

urinary retention

CSF PCR

negative MRI

intravenous acyclovir

myelopathic signs

acute rehabilitation

HSV Myelitis

Cerebrospinal Fluid Polymerase Chain Reaction

Ascending Sensory-Motor Symptoms

Intravenous Acyclovir

Hyperreflexia