CHOREA AS A PRESENTATION OF HERPES-SIMPLEX ENCEPHALITIS RELAPSE

Three infants, ages 3 months to 3 years, presented with chorea as the initial manifestation of herpes simplex encephalitis (HSE) relapse. Pa tient 2, treated with repeated 10 day courses of 30 mg/kg/day of acycl ovir, had no clear improvement in neurological status. Patient 1, trea ted with a repeated 10-day course, improved only to have another HSE r elapse 4 years later. Patient 3 clearly improved soon after a 3-week c ourse of acyclovir at conventional dosages. A fourth patient (Patient 4) who relapsed with chorea after what was thought to be HSE, and who did not respond to repeated acyclovir treatment, was negative for herp es simplex virus indicators on brain biopsy and DNA testing. We recomm end treating all patients suffering from HSE with a minimum 3-week cou rse of acyclovir at 30-35 mg/kg/day in 3 divided doses.