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Acyclovir-Responsive Glioma: The Need for Vigilant Diagnosis

대한신경초음파학회지 2020년 12권 2호 p.83 ~ 86
민영기, 김혜림, 김선덕, 이우진, 송승근, 이상형, 이용석,
소속 상세정보
민영기 ( Min Young-Gi ) - Seoul National University Hospital Department of Neurology
김혜림 ( Kim Hae-Lim ) - Seoul National University Hospital Department of Neurology
김선덕 ( Kim Seon-Deuk ) - Seoul National University Hospital Department of Neurology
이우진 ( Lee Woo-Jin ) - Seoul National University Hospital Department of Neurology
송승근 ( Song Seung-Geun ) - Seoul National University Hospital Department of Pathology
이상형 ( Lee Sang-Hyung ) - Seoul National University College of Medicine SMG-SNU Boramae Medical Center Department of Neurosurgery
이용석 ( 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.

키워드

Encephalitis, herpes simplex; Glioblastoma; Neuroimaging; Neuropathology

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