Acyclovir-Responsive Glioma: The Need for Vigilant Diagnosis
¹Î¿µ±â, ±èÇý¸², ±è¼±µæ, ÀÌ¿ìÁø, ¼Û½Â±Ù, ÀÌ»óÇü, ÀÌ¿ë¼®,
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¹Î¿µ±â ( Min Young-Gi )
Seoul National University Hospital Department of Neurology
±èÇý¸² ( Kim Hae-Lim )
Seoul National University Hospital Department of Neurology
±è¼±µæ ( Kim Seon-Deuk )
Seoul National University Hospital Department of Neurology
ÀÌ¿ìÁø ( Lee Woo-Jin )
Seoul National University Hospital Department of Neurology
¼Û½Â±Ù ( Song Seung-Geun )
Seoul National University Hospital Department of Pathology
ÀÌ»óÇü ( Lee Sang-Hyung )
Seoul National University College of Medicine SMG-SNU Boramae Medical Center Department of Neurosurgery
ÀÌ¿ë¼® ( Lee Yong-Seok )
Seoul National University College of Medicine SMG-SNU Boramae Medical Center Department of Neurology
Abstract
We report a case of an acyclovir-responsive glioma, which was initially misdiagnosed as herpes simplex encephalitis (HSE). Intravenous acyclovir alone, without corticosteroid, dramatically improved the patient¡¯s symptoms and magnetic resonance imaging findings. He developed headache and amnesia after 1 year, when the stereotactic brain biopsy confirmed the final diagnosis of a glioblastoma, isocitrate dehydrogenase-1 wild-type. In retrospect, some of his sero-radiologic findings were not consistent with HSE. Polymerase chain reaction for herpes simplex virus in the cerebrospinal fluid tested negative. Parieto-occipital involvement and absence of post-treatment atrophy were also signs against HSE. We suggested that a low-grade glioma was present from the beginning and later underwent malignant transformation. The diagnosis of HSE should be made carefully. Acyclovir might also work on gliomas; this is confirmed by a typical clinical picture of HSE and a clear acyclovir-response. A vigilant review of the paraclinical features may shed light on the correct diagnosis.
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Encephalitis, herpes simplex; Glioblastoma; Neuroimaging; Neuropathology
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