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HERPES SIMPLEX ENCEPHALITIS IN A PATIENT TREATED WITH INFLIXIMAB FOR ULCERATIVE COLITIS: A CASE REPORT AND LITERATURE REVIEW
maryam aleissa
*1,2, Jai Singh
1, Ryba Bhullar
1, Vijay Mittal
1, Ernesto Drelichman
1, Jasneet S. Bhullar
11Henry Ford Providence Hospital, Southfield, MI; 2Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
BackgroundInfliximab, a TNF-? inhibitor, treats moderate to severe ulcerative colitis (UC) due to its efficacy in inducing clinical remission. While the therapy is generally safe, the risk of viral and bacterial reactivation, including tuberculosis (TB) and hepatitis B (HBV), is a recognized concern. However, reactivation of herpes simplex virus (HSV) and the development of herpes simplex virus encephalitis (HSE) following infliximab therapy is a rare and poorly understood complication.
Case Presentation We report the case of a 54-year-old female with a history of UC, who presented with severe abdominal pain and bloody diarrhea consistent with an exacerbation of her disease. After partial response to corticosteroids, she was transitioned to infliximab therapy. Three days post-infusion, the patient developed acute confusion, aphasia, and respiratory distress, with initial imaging negative for stroke. Further investigation, including cerebrospinal fluid (CSF) analysis and MRI, revealed findings suggestive of central nervous system infection. Lumbar puncture confirmed the diagnosis of HSV-1. The patient was treated with intravenous acyclovir, leading to clinical improvement.
Discussion This case highlights the potential for reactivation of latent HSV in patients undergoing TNF-? inhibitor therapy, an association that has been rarely reported. Although TNF-? plays a crucial role in the immune response to HSV infection, the mechanisms by which TNF-? inhibitors trigger viral reactivation remain unclear. Few case reports have been published recently. Along with our case this underscores the importance of clinicians maintaining a high index of suspicion for HSV encephalitis in patients receiving TNF-? inhibitors, even in the absence of typical clinical or radiological findings.
ConclusionHerpes simplex virus encephalitis, while rare, should be considered in patients presenting with neurological symptoms following infliximab therapy. Early recognition and prompt initiation of antiviral therapy are crucial, especially in cases where diagnostic workup is inconclusive but clinical suspicion remains high.
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