Child Neurology: Intractable Epilepsy and Transient Deficits in a Patient With a History of Herpes Simplex Virus Encephalitis

Herpes simplex virus (HSV) is a neurotropic pathogen that can invade, replicate, establish latency, and reactivate within the CNS.1 Potential triggers of reactivation include immunosuppression, fever, and direct insult.1–3 HSV reactivation may cause recurrence of an infectious process, herpes simplex encephalitis (HSE), or recurrence of a relatively benign condition, Mollaret meningitis. Here we report the case of a patient with intractable epilepsy following a febrile illness at age 2 thought to be secondary to HSV. She ultimately underwent an anterior corpus callosotomy 2 decades later with a postoperative course complicated by HSV reactivation. Whereas the majority of cases of HSV reactivation occur within the first year of illness, it is important to recognize that this virus may remain dormant for years and later reactivate in the setting of physiologic stress.

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