Dual herpes virus reactivation complicated with encephalitis caused by direct-acting antiviral agents

研究成果: 雜誌貢獻文章

摘要

Direct-acting antiviral agents (DAAs) have been the mainstream treatment of hepatitis C because of tolerability and efficacy. A 67-year-old man presented with acute drowsiness preceded by headache after starting DAAs (sofosbuvir and velpatasvir) for treatment of hepatitis C. Herpes zoster and herpes simplex stomatitis were noted. Later, HSV-1 encephalitis was diagnosed based on positive HSV1-PCR of CSF, while other tests were negative including HSV2-PCR, syphilis, culture of bacteria, tuberculosis and fungus. Further study showed the presence of concomitant Sjögren syndrome. The patient recovered well with the combination of intravenous acyclovir and steroid. Immune reconstitution inflammatory response (IRIS) may be the most important mechanism of this patient’s severe illness. In conclusion, severe CNS infection instead of just peripheral nervous system involvement may occur due to herpes virus reactivation caused by DAAs. Screening of autoimmune markers may be considered before DAA therapy.
原文英語
頁(從 - 到)67-69
頁數3
期刊Neurology Asia
24
發行號1
出版狀態已發佈 - 三月 1 2019

指紋

Encephalitis
Antiviral Agents
Viruses
Hepatitis C
Polymerase Chain Reaction
Stomatitis
Herpes Simplex
Acyclovir
Sleep Stages
Peripheral Nervous System
Herpes Zoster
Human Herpesvirus 1
Syphilis
Headache
Tuberculosis
Fungi
Therapeutics
Steroids
Bacteria
Infection

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

引用此文

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title = "Dual herpes virus reactivation complicated with encephalitis caused by direct-acting antiviral agents",
abstract = "Direct-acting antiviral agents (DAAs) have been the mainstream treatment of hepatitis C because of tolerability and efficacy. A 67-year-old man presented with acute drowsiness preceded by headache after starting DAAs (sofosbuvir and velpatasvir) for treatment of hepatitis C. Herpes zoster and herpes simplex stomatitis were noted. Later, HSV-1 encephalitis was diagnosed based on positive HSV1-PCR of CSF, while other tests were negative including HSV2-PCR, syphilis, culture of bacteria, tuberculosis and fungus. Further study showed the presence of concomitant Sj{\"o}gren syndrome. The patient recovered well with the combination of intravenous acyclovir and steroid. Immune reconstitution inflammatory response (IRIS) may be the most important mechanism of this patient’s severe illness. In conclusion, severe CNS infection instead of just peripheral nervous system involvement may occur due to herpes virus reactivation caused by DAAs. Screening of autoimmune markers may be considered before DAA therapy.",
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AU - Chen, Hsiu Chen

AU - Cheng, Sheng Wei

AU - Sung, Jia Ying

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Direct-acting antiviral agents (DAAs) have been the mainstream treatment of hepatitis C because of tolerability and efficacy. A 67-year-old man presented with acute drowsiness preceded by headache after starting DAAs (sofosbuvir and velpatasvir) for treatment of hepatitis C. Herpes zoster and herpes simplex stomatitis were noted. Later, HSV-1 encephalitis was diagnosed based on positive HSV1-PCR of CSF, while other tests were negative including HSV2-PCR, syphilis, culture of bacteria, tuberculosis and fungus. Further study showed the presence of concomitant Sjögren syndrome. The patient recovered well with the combination of intravenous acyclovir and steroid. Immune reconstitution inflammatory response (IRIS) may be the most important mechanism of this patient’s severe illness. In conclusion, severe CNS infection instead of just peripheral nervous system involvement may occur due to herpes virus reactivation caused by DAAs. Screening of autoimmune markers may be considered before DAA therapy.

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