Acute transverse myelitis caused by herpes simplex virus; a rare case report = Acute transverse myelitis caused by herpes simplex virus; a rare case report

다국어 초록 (Multilingual Abstract)

Background: Acute transverse myelitis (ATM) refers to inflammation or demyelination across the width of the spinal cord in the absence of pre-existing neurologic disorder. Identifying the cause of transverse myelitis is often challenging, and in many circumstances the cause remains unknown. We report a extremely rare case of ATM caused by herpes simplex virus type 1 infection (HSV-1), which is the first case report in Korea to our knowledge. Case report: A 29-year-old male without remarkable past medical history. presented with febrile sense and oral pain for one weak. Initial body temperature was 37.9℃ and other vital signs were stable. Initial physical examination revealed multiple oral ulcers, and findings on respiratory, cardiac, and abdominal evaluation wereunremarkable. No neurologic deficit was noted. Abnormal laboratory findings included leukocytosis (WBC 10820/μl), elevated C-reactive protein(1.85 mg/dl) and erythrocyte sediment rate (29 mm/hr). On 3rd hospital day, patientcomplained dysethesia in lower extremities and voiding difficulty. Neurologic examination demonstrated grade V- motor weakness in lower extremities. Cerebrospinal fluid(CSF) analysis revealed pleocytosis(WBC 28/mm3, RBC 0/mm3), glucose and rotein in normal range. Spine magnetic resonance imaging noted central T2 high signal intensity from C7 to T10 around gray matter of spinal cord suggesting myelopathy. Blood HSV-1 polymerase chain reaction test was positive. He was diagnosed HSV-1 ATM and treated with intravenous acyclovir for 2 weeks with methylprednisolone for one week. Motor dysfunction was fully recovered, but sensory and autonomic dysfunction remained. The patient was discharged for outpatient follow-up and rehabilitation. Conclusion: This is the first case report of ATM caused by HSV-1 in Korea. Since ATM can bring profound and devastating neurologic sequelae, HSV ATM should be taken into consideration in a patient of HSV infection with neurologic symptoms,apart from other CNS diseases such as Guillain-Barre syndrome or radiculopathy.