ACUTE LYMPHOBLASTIC LEUKEMIA WITH RECURRENT HERPES SIMPLEX ENCEPHALITIS: A CASE REPORT AND LITERATURE REVIEW

Abstract

Objective To investigate the clinical features of children with acute lymphoblastic leukemia (ALL) and herpes simplex encephalitis (HSE) and related diagnosis and treatment regimens. Methods Related clinical data were collected from a child with ALL and recurrent HSE who were admitted to our hospital, and a literature review was performed. Results A boy, aged 9 years, developed the manifestations of pyrexia, abnormal olfactory function, disturbance of consciousness and cognitive impairment, memory loss, and personality changes during remission induction therapy for ALL (intermediate-risk). Routine cerebrospinal fluid examination showed mild leukocytosis (mainly mononuclear cells); biochemical examination of cerebrospinal fluid showed a mild increase in protein; cranial MR showed patchy long T1 and long T2 signal shadows in the bilateral temporal insula and the right posterior frontal lobe; high-throughput sequencing of pathogenic microorganism in cerebrospinal fluid showed positive herpes simplex virus type 1. The symptoms gradually disappeared after antiviral therapy with acyclovir, anti-inflammatory therapy with methylprednisolone, and immune supportive therapy with gamma-globulin, with normal results of routine cerebrospinal fluid examination and biochemical examination. At 5 months after the cessation of antiviral therapy, the child had the recurrence of HSE during induction chemotherapy, and his clinical symptoms were improved after acyclovir treatment. Conclusion ALL comorbid with HSE is rare in children, and high-intensity chemotherapy may induce HSE. Due to a lack of typical clinical manifestations, early identification and treatment may help to improve prognosis.

Keywords

• precursor cell lymphoblastic leukemia-lymphoma|encephalitis, herpes simplex|child|case reports