RELAPSE OF HERPES-SIMPLEX ENCEPHALITIS

We report five children who had recurrent central nervous system signs after conventional acyclovir therapy for herpes simplex encephalitis. Secondary exacerbation was characterized clinically by severe ballism ic movement disorder in all five children, associated with fever, impa irment of consciousness, and seizures. Biologic analysis in all childr en and magnetic resonance imaging and neuropathology studies of the br ain in three cases were compatible with inflammatory reaction. In cont rast, all viral cultures remained negative, herpes simplex virus antig en in one child and DNA tested by polymerase chain reaction in four ch ildren were undetectable in the first samples of cerebrospinal fluid d uring the relapse, suggesting a postinfectious, immune-mediated mechan ism of relapse in these patients.