Seventeen-day-old twins were hospitalized for neonatal herpes simplex virus 1 (HSV-1)
with central nervous system disease and internal capsule and thalamic lesions on magnetic
resonance imaging (MRI). They were treated with the usual intravenous (IV) treatment
and oral therapy for 6 months. The clinical course was good in both children with
negative HSV polymerase chain reaction on completion of IV therapy. The neurological
condition recurred in one child with new radiological lesions at 7 months of age,
2 weeks after discontinuation of oral treatment. Cerebral lesions highlighted on the
MRI scan are specific to the neonatal period and impact long-term prognosis. The likely
genetic predisposition in this case is interesting and requires further investigation.
In addition, this case raises questions about the duration of oral acyclovir suppressive
therapy.
Keywords
recurrence of CNS disease - neonatal HSV infection - suppressive therapy
